Almost every client who hires me to be their doula has a common preference: They would like to avoid a C-section.
Lucky for them, they’ve taken an important and impactful step towards reducing their cesarean risk: They hired me.
Hiring a doula can reduce the risk of a surgical birth by up to 25%.
In the United States, C-sections have become the most common surgical procedure. And these surgeries are taking place at a rate much greater than that determined to be beneficial, at least on a population scale. In simple terms, many of these surgeries were likely to have been unnecessary.
If you are planning a vaginal birth, there are a few things you can do to REDUCE your risk of experiencing an UNNECESSARY C-section.
In a nutshell, my advice boils down to: Be mindful about your choice of birth team and birthing location. Educate yourself on current recommendations about cesareans for big babies and slow labor. Spend as little time as possible in the hospital when you are in early labor.
Individually, these simple actions can reduce your chance of C-section by 25-30%. Imagine what happens when you chain them together!
Ultimately, you will always be your best advocate. Learn what you can, plan what you can, and then enjoy the ride.
Here’s the full-bodied version:
1) Shop around when choosing your birthing location.
Birthing location is an independent risk factor for C-section (1). C-section rates vary widely hospital-to-hospital (2). Their cesarean rate tells you a lot about the culture amongst the docs and nursing staff. Your doc might have a low C-section rate, but chances are, your on-call OB will not be your doc.
2) Research your medical provider.
While the hospital’s cesarean rate might be a more important variable, it’s still worth knowing the philosophy of your primary doc. Ask your provider about policies and procedures surrounding vaginal births and C-sections.
3) If you are low-risk, consider working with a midwife.
Midwife-attended births are associated with a much lower risk of Cesarean (3). There are different types of midwives and midwives support births at home, in birth centers and in hospitals. Even if you desire a hospital birth, you may be able to choose a midwife to attend your birth.
4) Hire a doula.
The presence of continuous labor support reduces the occurrence of C-sections by 25% and the benefit is even greater when that labor support is a trained doula (8).
5) Don’t get too excited about big babies.
The American College of Obstetricians and Gynecologists (ACOG) doesn’t recommend C-section for large babies unless their guesstimated to be at least 11 lbs, in a non-diabetic parent, or 9 lb 15 oz in a diabetic parent (7). Babies that large are fairly rare.
It’s also worth noting, your pelvis is remarkably mobile. A doula can help you move in ways to maximize space in the pelvic and increase the diameter of the pelvic outlet.
6) Stay home as long as possible during early labor.
Aim to arrive at the birthing location during active labor (e.g. 4, 5, 6). The more time you spend in the hospital before you are in active labor, the greater your risk of incurring a diagnosis of a stalled or non-progressing labor.
7) Give yourself time.
ACOG recently updated their recommendations and allows labor to progress for longer, as long as the birthing parent and baby are doing well. Familiarize yourself… or making sure your doula is familiar… with the current recommendations and definitions surrounding arrested (stalled) labor (7,9).
C-sections aren’t bad. But they are overused. If your OB tells you that your life or your baby’s life is in danger- that’s not the time to argue!
If you want to avoid an unnecessary Cesarean, prepare AHEAD of time with some of the tips on this list. Find medical professionals and a care team you can trust. Because once you’re in their care, you want to be able to trust their recommendations.
As you’re preparing for birth, don’t forget to consider these 3 things:
Before the Birth Plan: To Increase Your Chance of Vaginal Delivey, Choose a Birth Team and Birthing Location That Align With Your Preferences
(1)Plough, Avery C., et al. “Relationship Between Labor and Delivery Unit Management Practices and Maternal Outcomes.” Obstetrics & Gynecology, vol. 130, no. 2, Aug. 2017, pp. 358–65. DOI.org (Crossref).
(2)McKenzie, L., and P. A. Stephenson. “Variation in Cesarean Section Rates among Hospitals in Washington State.” American Journal of Public Health, vol. 83, no. 8, Aug. 1993, pp. 1109–12. DOI.org (Crossref).
(3)Souter, Vivienne, et al. “Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births.” Obstetrics & Gynecology, vol. 134, no. 5, Nov. 2019, pp. 1056–65. DOI.org (Crossref).
(4) Miller, Yvette D., et al. “Variations in Outcomes for Women Admitted to Hospital in Early versus Active Labour: An Observational Study.” BMC Pregnancy and Childbirth, vol. 20, no. 1, Aug. 2020, p. 469. BioMed Central.
(5)Balcik Colak, Melek, and Hafize Ozturk Can. “Effects of the Time of Pregnant Women’s Admission to the Labor Ward on the Labor Process and Interventions.” Health Care for Women International, Feb. 2020, pp. 1–17.
(6)Rahnama, P., et al. “Impact of Early Admission in Labor on Method of Delivery.” International Journal of Gynecology & Obstetrics, vol. 92, no. 3, Mar. 2006, pp. 217–20.
(7)Safe Prevention of the Primary Cesarean Delivery. https://www.acog.org/en/clinical/clinical-guidance/obstetric-care-consensus/articles/2014/03/safe-prevention-of-the-primary-cesarean-delivery. Accessed 3 May 2021.
(8)Bohren, Meghan A., et al. “Continuous Support for Women during Childbirth.” Cochrane Database of Systematic Reviews, edited by Cochrane Pregnancy and Childbirth Group, July 2017.
(9)Friedman’s Curve and Failure to Progress: A Leading Cause of Unplanned Cesareans
https://evidencebasedbirth.com/friedmans-curve-and-failure-to-progress-a-leading-cause-of-unplanned-c-sections/.Accessed 3 May 2021.
Your first step in returning to exercise after a C-section.
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Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I also offer personal training services and consultations to folks locally (Seattle, Bellevue, Redmond, Kirkland) and online.