Safely, Naturally Reduce Your Risk of C-Section

As Americans embrace complementary therapies, women are increasingly interested in natural and/or less interventional birthing approaches. But if you are planning a hospital birth, it takes more than good luck to avoid a C-section.

 Pregnant women should be alarmed by recent news that the nation’s Cesarean section rate has reached an all-time high. The number of C-sections has risen 50% since 1996, according to the CDC, making the surgery the most common operation performed in U.S. hospitals.

 Nearly one-third of births nationwide were performed via C-section in 2007, and in Connecticut, C-section rates were slightly higher than the national average (34.6%), running to over 40% in many local hospitals.

 If you are planning to have a baby anytime soon, this is not good news. Ideally you want to avoid this major surgical procedure that involves a longer recovery time, an overall higher risk of complications, the greater likelihood of infection, hemorrhage, injury to the bowel and bladder, increased risk for future pregnancies and the possibility of compromised fertility in the future compared with vaginal delivery.

Impersonal care and malpractice fears

 A combination of factors has led to this dramatic increase in Cesareans, including a less personalized approach to care and the threat of lawsuits over bad outcomes. In a recent poll of 5,644 doctors conducted by the American College of Obstetricians and Gynecologists (ACOG), 29% of OB/GYNs said the fear of lawsuits has prompted them to perform more C-sections.

 This trend has created a vicious cycle, because women who have their first baby via C-section are far more likely to deliver subsequently the same way. The number of vaginal deliveries after Cesarean (known as VBACs) dropped from a high of 28.3% of all C-sections to 7.9% in 2005.

 The main risk associated with VBAC is a 1% possibility of uterine rupture, but fetal distress can rapidly ensue, requiring an emergency C-section. ACOG and many studies support the use of VBAC under the right circumstances, and if the patient is appropriately counseled. However, many doctors routinely advise women against it, deeming the small risk not worth the chance of a bad outcome and subsequent lawsuit. Many physicians have given up the practice of delivering vaginal births after Cesarians altogether.

Patients also responsible

 Another reason for the rising C-section rate is that fewer doctors deliver breech babies vaginally any more. While severe neurologic injury can occur in rare cases, about 50% of breech babies can be safely turned head down using a procedure known as version, the manual turning of a malpositioned baby. Unfortunately, many doctors are no longer adequately trained or experienced in this procedure, and others stopped doing it because the small risk of complications exposes them to lawsuits.

 Finally, patients are also partly responsible for the alarming rise in C-section rates. As more Americans become overweight, similar trends appear in our pregnant population. The more overweight or obese a patient is, the higher the C-section rate. These pregnancies are also more likely to be complicated by gestational diabetes, adding a higher likelihood of C-section.

 Cesareans are sometimes necessary, of course. The most common reasons include fetal distress, unresolved arrest of labor, malpresentations such as breech babies and some multiple pregnancies. However, women can safely reduce their chances of having a C-section by making a number of good choices.

Seven wise choices:

 Research medical practices

Women should not be afraid to interview prospective doctors. Ask, “What is your C-section rate?” and inquire whether they are comfortable with and knowledgeable about facilitating a natural or low intervention childbirth (high-risk OB/GYNs are more likely to perform Cesareans). Consider contacting a health care worker at the local hospital, such as a labor and delivery nurse, for recommendations.

 Create a birth plan early on

 Instead of handing your doctor a birth plan when you are eight centimeters dilated, discuss your birth plan during prenatal visits and make your goals clear to all medical professionals involved in your birth experience.

Consider hiring a doula

Years of experience working with doulas has given me ample confidence that a good doula can help women safely achieve a natural or low-intervention childbirth. If you can’t afford one, ask to be teamed up with a labor and delivery nurse who will work with you.

Strive for optimal (not just adequate) nutrition and supplementation

Eating nutritious foods can help women reduce their chances of having a C-section, primarily because they’re less likely to gain too much weight. In addition, taking supplements beyond run-of-the-mill recommendations can address particular pregnancy-related symptoms and chronic conditions affecting pregnancy. For example, recent studies show that optimal levels of vitamin D taken during pregnancy may reduce the risk of having a C-section.

Continue to exercise and use mind-body skills

Most women can continue to exercise throughout the pregnancy, as long as they follow the most up-to-date guidelines. Make sure your doctor knows these and does not unnecessarily make you give up a regular fitness routine. Exercise may reduce the risk of a Cesarean birth by limiting weight gain. Exercise, chiropractic work and yoga can also help make the pain of labor more tolerable.

Consider having a VBAC

At your first appointment, ask your doctor if he or she performs VBACs, and whether you are a candidate. Factors include the type of incision used, prior vaginal deliveries, what prompted your first C-section, and how many you’ve had. Between 60% and 80% of women who try VBAC are successful, according to ACOG.

 Resist the temptation to be induced unnecessarily

Don’t ask to be induced or yield to pressure to be electively induced unless there’s a clear medical reason, since this greatly increases your chances of having a C-section. Most doctors agree that electing to have a C-section if you do not have any risk factors should also be avoided.

Russell Turk, MD, is the founder of Riverside Obstetrics & Gynecology, which combines state-of-the-art medical care with safe and natural options for women. Located at 1200 East Putnman Avenue in Riverside. Call 203.637.3337 for more information or to schedule an appointment.