1. Choose your birth attendants and birth place wisely.
-Ask yourself which people and which facilities are most likely to give you the best and safest birth. Remember that of the three birth places (home birth, birth center, hospital birth), the choice of hospital is most likely to result in a Cesarean.
-Interview your prospective OB to make sure he/she is not stuck on the horizontal birthing position. What is their point of view about walking/movement in labor and vertical birthing. Would they accommodate a squatting or side-lying position? Try to determine his/her birth philosophy. Do they have a relaxed attitude or do they seem to be preoccupied with a lot of "what ifs"? What is their personal cesarean rate? Anything over 15% suggests a predominately surgical mind-set about birth. Ask about electronic fetal monitors and other routines.
2. Bring a birth buddy.
The following statistics are taken from the book Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier and Healthier Birth, by Klaus, Kennell, and Klaus (1993):
50% reduction in the cesarean rate
25% shorter labor
60% reduction in epidural requests
40% reduction in oxytocin use
30% reduction in analgesia use
40% reduction in assisted deliveries (Vacuum extraction or forceps)
3. Think Upright. Back-lying is the position for a cesarean; not a vaginal birth. The more time you spend in the cesarean position, the more likely you are to need one. Research has shown that laboring in an upright position increases uterine efficiency, shortens labor, dilates the cervix better, and allows the labor to progress more comfortably and efficiently.
-My doula told me the story of a woman she was working with in a hospital here in Korea. She had been in labor for many hours and it came to a point where the doctor came and told her she needed to have a c-section. My doula asked for just 30 minutes more and also permission for the mother to get up out of the bed. She got up and got into a squatting position and the baby descended all the way in less than 5 minutes and her cervix completely opened up. Amazing, huh! Birthing horizontally also allows gravity to pull the baby down.
-The horizontal position is one of those "habits" that has been carried over from the days of anesthetized births and forceps delivery where women who were during during delivery couldn't stand up or even help push their babies out.
Just because a woman chooses to upright doesn't mean she can never lie down. Many women are able to lie down on their sides periodically or rest in other positions. Bottom line: Freedom of choice in laboring positions is the best bet for a vaginal birth.
4. Take a walk.
Research has shown that walking helps labor progress and is good for the baby. Again, gravity is in your favor here.
5. Be careful with electronic fetal monitoring and other interventions.
-Advocates of routine EFM claim that it reduces the number of stillborn and brain-damaged babies by alerting doctors to early signs of trouble. Before its usefulness was even proven, it became a standard medical procedure and once again, nowadays physicians hesitate to deviate from that standard (most likely for fear of a lawsuit). These studies also showed that the mothers who used this technology were twice as likely to have a surgical birth.
- There are several controlled studies out there that show that low-risk mothers have shown no difference in infant outcome between EFM or a person monitoring the baby using a stethoscope. The problem with continuous EFM is that it can sometimes give false alarms. Also it restricts the mother's movement- see number 3 for why this is a problem.
-As soon as the EFM monitor is placed around your abdomen, your chances of having a cesarean go up. In some cases, however, EFM can spare the mother from a cesarean. For example, if your doctor says your labor is not progressing but the EFM shows no sign of fetal distress or that the baby is bothered by this long labor, the doctor will probably be more inclined to let you labor longer instead of rushing to a cesarean.
6. Get educated about Epidurals
-Be careful and inform yourself about epidurals. In some cases, a well-time epidural can actually reduce the risk of a C-section because the mother is able to relax and even rest during birth. On the other hand, overuse can effect the efficiency of the uterus to have contractions and you also will no longer be able to be vertical (See #3 and #4)
7. Take your time
-Birth shouldn't be rushed. Don't feel pressured to give birth in a hurry because of others' convenience or timetables. As long as you are fine and your baby is fine, there is no need to rush or hurry. Often times the mother's "failure to progress" is really the doctor's "failure to wait." There is no evidence that a long labor in and of itself is harmful to a baby. There are charts of "normal labor" but these were set decades ago (by men) and just because that may be "normal" for one woman, doesn't mean it is "normal" for you.
***If you are planning a hospital birth, it is best to labor at home as long as possible. Not only does this keep you more comfortable, it reduces the risks of intervention and pressure to have the baby in a certain time frame.
-This is where relaxation comes in and is SO important. A mother who is well prepared for birth, who knows how to relax and what her body's signals mean, is better able to handle a long, drawn-out labor. She knows how to avoid exhaustion, she is able to stay with her original plan rather than getting scared and opting for a cesarean.
8. Use discernment with managed births.
-This might be something like a woman booking her birth sometime near her due date. She enters the hospital, gets induced with pitocin, and gets an epidural to manage the pain. The labor is chemically, not naturally, stimulated stimulated, electronically monitored, and technically managed. The birth changes from a physiological event to a medical event. Research has proven that this type of birth is more likely to end in a Cesarean.
-Something else to consider with a managed birth: Pitocin-stimulated contractions are much more painful than the ones naturally stimulated by the hormone oxytocin (produced by the mother's body).
9. Lobby for legal change
-Obstetricians interviewed by Dr. Sears said they believed the Cesarean rate could be cut down to less than 10% if there were no fear of being sued. Some indications for cesareans are gray ares, but doctors- for fear of legal implications- often step into a "take no chances" mindset which leads straight to the operating room. Doctors aren't going to lower cesarean rates; women must.
10. Plan ahead.
-When you are in the moment, being offered a surgical birth might seem like the greatest option ever. "In the moment" is not a time to be making such a decision. Part of your prenatal preparation should be learning about the indications for a cesarean birth; which ones are absolute and which ones are judgment calls that can go either way.
-Be careful and inform yourself about epidurals. In some cases, a well-time epidural can actually reduce the risk of a C-section because the mother is able to relax and even rest during birth. On the other hand, overuse can effect the efficiency of the uterus to have contractions and you also will no longer be able to be vertical (See #3 and #4)
7. Take your time
-Birth shouldn't be rushed. Don't feel pressured to give birth in a hurry because of others' convenience or timetables. As long as you are fine and your baby is fine, there is no need to rush or hurry. Often times the mother's "failure to progress" is really the doctor's "failure to wait." There is no evidence that a long labor in and of itself is harmful to a baby. There are charts of "normal labor" but these were set decades ago (by men) and just because that may be "normal" for one woman, doesn't mean it is "normal" for you.
***If you are planning a hospital birth, it is best to labor at home as long as possible. Not only does this keep you more comfortable, it reduces the risks of intervention and pressure to have the baby in a certain time frame.
-This is where relaxation comes in and is SO important. A mother who is well prepared for birth, who knows how to relax and what her body's signals mean, is better able to handle a long, drawn-out labor. She knows how to avoid exhaustion, she is able to stay with her original plan rather than getting scared and opting for a cesarean.
8. Use discernment with managed births.
-This might be something like a woman booking her birth sometime near her due date. She enters the hospital, gets induced with pitocin, and gets an epidural to manage the pain. The labor is chemically, not naturally, stimulated stimulated, electronically monitored, and technically managed. The birth changes from a physiological event to a medical event. Research has proven that this type of birth is more likely to end in a Cesarean.
-Something else to consider with a managed birth: Pitocin-stimulated contractions are much more painful than the ones naturally stimulated by the hormone oxytocin (produced by the mother's body).
9. Lobby for legal change
-Obstetricians interviewed by Dr. Sears said they believed the Cesarean rate could be cut down to less than 10% if there were no fear of being sued. Some indications for cesareans are gray ares, but doctors- for fear of legal implications- often step into a "take no chances" mindset which leads straight to the operating room. Doctors aren't going to lower cesarean rates; women must.
10. Plan ahead.
-When you are in the moment, being offered a surgical birth might seem like the greatest option ever. "In the moment" is not a time to be making such a decision. Part of your prenatal preparation should be learning about the indications for a cesarean birth; which ones are absolute and which ones are judgment calls that can go either way.
For more information, read the following articles
CNN article: 5 ways to avoid a cesarean: http://articles.cnn.com/2007-08-23/health/ep.csection_1_c-section-stratton-labor/2?_s=PM:HEALTHHow does a cesarean affect the baby: http://www.vbac.com/how-does-a-cesarean-affect-the-baby/
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