Six Ways to Reduce Your Risk of Cesarean

Around 1 in 3 babies are born via cesarean section in the United States. While abdominal birth is sometimes necessary and life-saving, the percentage of babies born this way should be closer to 10-15%.

Here’s what the American College of Obstetricians and Gynecologists (ACOG) has to say:

Although cesarean delivery can be lifesaving for the fetus, the mother, or both in certain cases, the rapid increase in the rate of cesarean births since 1996, without evidence of concomitant decreases in maternal or neonatal morbidity or mortality, raises significant concerns about contemporary cesarean delivery rates.

Cesarean surgery comes with additional risk in the present moment but also for any subsequent births. The benefits of a necessary cesarean outweigh these risks. But birthing people and babies are subjected to increased health risk FOR NO REASON (other than maybe a perceived reduction in financial risk for providers and institutions) when cesarean surgery is used inappropriately.

So what can you do to reduce your own risk? Here are six ways:

#1 Practice “Proactive Patience” if the First Stage of Labor is Progressing Slowly

“Failure to progress” is a vaguely-defined (and now outdated) term that has been a top reason for having a first-time cesarean. Understanding that “failure to progress” was often just “failure to wait” on the part of the provider is important. 

But the reality of a long first stage is that it can be exhausting. And it can be really stressful and frustrating to experience the intense sensations of labor for long periods of time and find out there has been no change at all to your cervix. I have been there, and, honestly, it felt utterly defeating. So patience alone may not be enough when progress has slowed or stalled in active labor (≥6 cm dilation). Having ideas for strategies to try (like upright labor positions) when a more proactive approach is needed can be really beneficial.

It’s also helpful to be aware of current terms and guidelines. Arrest of labor is the term used now instead of failure to progress.

Definition of arrest of first stage labor:

Spontaneous labor: ≥6 cm dilation with membrane rupture and 1 of following: ≥4 h of adequate contractions (eg, >200 Montevideo units); ≥6 h of inadequate contractions and no cervical change.

One big takeaway to remember from this definition is that arrest of first stage labor shouldn’t be diagnosed in the latent phase of labor and when the cervix hasn’t reached 6 cm dilation. The reality of the latent phase or early labor is that it can take awhile. 

#2 Learn More About Your Options for Fetal Monitoring

The number two reason for first-time cesareans is “non-reassuring fetal heart tones”. In a hospital setting, routine use of continuous electronic fetal monitoring (EFM) is widespread.

According to Evidence Based Birth:

Electronic fetal monitoring (EFM) was brought into labor rooms in the 1970s, despite the fact that there was no research evidence to show that it was safe or effective. Randomized trials have found that EFM has contributed to an increase in the Cesarean rate, without making any improvements in cerebral palsy, Apgar scores, cord blood gases, admission to the neonatal intensive care unit, low-oxygen brain damage, or perinatal death (which includes stillbirth and newborn death). EFM is linked to a lower rate of newborn seizures; however, newborn seizure events are rare and it is not clear how often they lead to long-term health problems.

Talk to your care providers about alternatives, like intermittent auscultation, which can reduce your risk of unnecessary cesarean surgery. This isn’t going to be a recommended option for everyone, depending on specific circumstances.

Intermittent auscultation means a care provider listens (often with a hand-held fetal Doppler ultrasound device) to fetal heart rate for short periods of time at regular intervals. At the same time, a care provider monitors contractions (strength, frequency, and duration) by putting their hands on the abdomen of the person in labor to feel them.

Here’s what ACOG has to say on this:

To facilitate the option of intermittent auscultation, obstetrician–gynecologists and other obstetric care providers and facilities should consider adopting protocols and training staff to use a hand-held Doppler device for low-risk women who desire such monitoring during labor.

#3 Choose an Aligned Care Provider

Choose a care provider that practices evidence-based care and is committed to avoiding unnecessary surgery. This is one of the most important decisions you can make for your birth experience, because it affects your labor will be managed and which preferences will be available and supported. Most people give birth under the care of an obstetrician (experts at managing complications), but midwives (experts in supporting physiologic birth) are a great alternative to consider.

#4 Research Your Options for Birth Location

Find out what the cesarean rates are at any hospitals you are considering. It can vary widely (thanks to hospital policies that aren’t always evidence-based). You can also explore your options for community birth (birth center or at home). What’s available will depend on where you live and on your health insurance plan.

🔗 Your Biggest C-Section Risk Might Be Your Hospital | Consumer Reports

#5 Explore Your Options if Your Baby is Breech

A cesarean section may be recommended if your baby is breech in the final weeks of pregnancy. Ideally, your baby will be in a head-down position for birth, but this is’t always the case. Breech means your baby is positioned in a way where their butt, feet, or both will come out first. 

Talk to your care providers about your options, if you’re hoping to avoid a cesarean. One option to consider is external cephalic version (ECV). This is when a care provider puts their hands on the abdomen of the pregnant person and attempts to roll the baby into a head-down position. You can read more about this at the link below:

🔗 The Evidence on: Breech Version

Vaginal breech birth could also be an option. Talk to your care provider about risks and benefits of this versus scheduled cesarean. You’ll also need to find out if this is something your care provider is willing to do. Vaginal breech birth isn’t something every care provider has the skills and experience to attend.

#6 Hire a Doula

Doulas are trained labor support people, and research shows they reduce the risk of cesarean. While not medical professionals, they can help with non-medical comfort measures, suggesting which labor positions could be beneficial, advocacy, and so much more. Also, doulas don’t replace your spouse or partner. They just add an additional layer of support.

What If I’ve Had a Cesarean in the Past?

If you’ve had a prior cesarean, you may have options for avoiding another one in the future (if that’s your preference). It’s possible to have a vaginal birth after cesarean (VBAC). If you decide this option may be for you, it’s REALLY important to find a care provider and birth location that is actually supportive of VBAC. The website below is a great resource for learning more about VBAC:

🔗 VBAC Facts®

Scheduling a repeat cesarean is also an option.

It’s important to consider the risks and benefits of VBAC versus repeat cesarean in the context of your specific pregnancy and your preferences, priorities, and goals. Discussions with your care providers are an important part of the decision-making process.

What If I Really Do Need a Cesarean?

While it’s so beneficial to take action in reducing the risk of cesarean, there are times when it is absolutely appropriate and life-saving. One thing I really want to emphasize is that cesareans themselves are not the problem. A cesarean birth is not a failure. The goal here is never to avoid necessary medical interventions. The problem lies with the OVERUSE of this medical intervention. This is a really important distinction.

But when plans have to change, a wide range of emotions is normal. Should a cesarean become necessary, it can he helpful to have your decisions documented on a birth plan. There are ways to enhance the experience to feel more like a family-centered birth and less like a medical procedure.

What If I Want a Cesarean?

According to ACOG:

…it is estimated that 2.5% of all births in the United States are cesarean delivery on maternal request.

If you have reasons for wanting an elective cesarean, this is an important discussion to have with your care provider. 

You can read more on ACOG‘s recommendations on this topic at the link below:

🔗 Cesarean Delivery on Maternal Request | Committee Opinion | ACOG