How to reduce your chances of a C-Section

How to reduce

your chances of a C-Section

Potentially Sensitive Discussion Ahead

Warning: This article is going to discuss evidenced based ways that a person may be able to avoid an unnecessary C-section, for those who desire to do this.  Throughout this discussion, please know that Fit For Birth acknowledges that C-sections are a valuable part of medical advancements, and are absolutely the best option in many cases, and at times also for many personal reasons. We support a mother’s right to choose what is right for her and her baby.  There are many reasons why a C-section might be medically necessary – for example, if baby is breech or transverse, if baby is in distress, or if mom or baby have a medical condition that would make a vaginal birth too risky. There could also be issues with the placenta or umbilical cord that might make a vaginal delivery physically impossible. C-sections can be life-saving, unavoidable surgeries, but they are just that – major abdominal surgeries. And like any major surgery, they can have very serious risks.

The rate of C-sections has been on the rise among seemingly low-risk, healthy moms who have intended not to have a C-section. What can be done to try and avoid a C-section if you don’t need one?

You may be surprised to hear that the number one scientifically proven method for avoiding C-section is actually to exercise during pregnancy. Women who exercise during pregnancy have a 75 percent decrease in the risk of C- section.^[1] Varney’s Midwifery reports this figure as “a substantially decreased rate of cesarean birth” and that “sedentary women were 4.5 times as likely as exercising mothers to deliver by cesarean.”^[2] . This means that exercise alone appears to lower one’s C-section risk from one in three to about one in twelve.

This fact is especially important when the pregnant woman understands how modern birthing is often set up for surgery. In the hospital maternity ward, one thing leads to another, starting a sequence of events that frequently culminates in “a slippery slope” toward C-section. Here is how it happens.

 

One: Time-Based Protocols

The sequence that commonly occurs in hospital births begins with the pressure of time. Hospital staff have a protocol that is time-based. Since 1955^[3], the suggested timetable for dilation has traditionally been considered to be about 1cm every hour (after she reaches about 3 cm dilation). “Friedman’s Curve is a graph that care providers have traditionally used to define a ‘normal’ length and pace of labor–giving first-time mothers about 14 hours to go from zero to ten cm and experienced mothers eight hours (Friedman 1955). If a cervix does not dilate according to this schedule, she may be assigned a diagnosis of Failure to Progress and taken to the operating room for a Cesarean.”^[4] As one Australian birth educator put it, “After being admitted to the maternity ward, the woman is then expected to dilate an average 1cm per hour…A dilation rate of less than 1cm per hour is considered abnormal and labelled a ‘failure to progress’.”^[5]

A 2002 study summarized the problem occurring in hospitals, as well as the need to adjust expectations: “The labor curve has a profound impact on the diagnosis of protraction and arrest disorders and the decision on cesarean delivery. Our results suggest that the pattern of labor progression in contemporary obstetrics differs significantly from the Friedman curve. The diagnostic criteria for protraction and arrest disorders may be too stringent in nulliparous women.”^[6]  In 2011, a change was still being requested: “Nulliparous women with spontaneous labor onset have longer ‘active’ labors and, hence, slower dilation rates than are traditionally associated with active labor when commonly used criteria are applied as the starting point. Revision of existing active labor expectations and/or criteria used to prospectively identify active phase onset is warranted.”^[7]

The problem is that it can take a long time for hospitals and medical staff to adjust protocols. When reflecting that a first time birth commonly takes 12-24 hours^[8],[9], how might an expectation of “1cm per hour” fare?

In addition, hospital expectations commonly envisage  pushing for first time moms to take one to two hours. Laws in most states also say that a birth must occur within 24 hours after the water breaks (or is broken for her), or surgery must be performed.

If mom is not on schedule, her chances for delivering naturally are in trouble. The unsuspecting mom may enter the hospital early, wanting to feel prepared or simply wishing to feel the ease of an expert opinion. She then becomes subject to having that clock start too early. If she and her baby are naturally destined for a longer labor, hospital staff begin to worry. If the pregnant mom is sedentary, she may gestate longer or fatigue sooner than one who exercises, again requiring more time. As time moves on, nurses and attendants worry more. The staff increasingly becomes paranoid about whether or not things are progressing “on schedule.” As the process unfolds, and mom also begins to feel the pressure of time, she elicits the very same stress response that is proven to slow labor even further.

 

Two: Hospital Mindset for Drugs

Most nurses simply expect to administer drugs for childbirth. In the birthing documentary, Business of Being Born, the interviewer asks three hospital nurses “How often do you get to see a fully natural birth?” The three fall quiet, looking to each other for an answer. Finally, one breaks the ice with “rarely” before another admits, “almost never.” If these nurses do not practice allowing natural births, how could they be expected to coach one?

Meanwhile, stress builds for mom as the experts recommend “helping” her contractions with drugs. To complicate matters, mom may be offered drugs before she is offered help choosing appropriate birthing positions and other traditional natural guidance. She may find herself on her back, partially constrained by the IV or other monitoring devices, and further removed from the possibility for natural birth.

 

Three: Needing to “Speed Things Up”

Eventually, pressures from the staff wither all but the most natural-minded and informed moms. Drugs at delivery are so widely administered that some moms are not even informed when it is given, but told only after the drug has been put into her IV fluid. The Journal of Perinatal Education, in 2014 reported, “More than four out of ten respondents (41%) indicated that their care provider tried to induce their labor…resulting in an overall rate of medically induced labor of 30%.”^[10]  This number reflects induction, and does not include additional Pitocin given once labor has begun (augmentation), nor the Pitocin given after birth for placental delivery. Though cumulative numbers are notoriously difficult to find, a cultural anthropologist at the University of Texas, Robbie Davis-Floyd, surveyed U.S. hospitals and in her 1992 book, “Birth as an American Rite of Passage,” reported the overall figure to be 81%.^[11]

Pitocin quickly overrides the body’s natural oxytocin contractions and often forces contractions that are more intense. The intensity can be much more than natural contractions–intense pain and lack of normal break-times can be the most noticeable changes. Whether mom can endure five or five hundred of these stabbing contractions often depends on her determination, her ability to relax, and her physical endurance.

 

Four: “Epidurals Please!”

Once the new Pitocin-caused contractions roll in, epidurals suddenly become another drug to consider, regardless of whether or not they are on mom’s birth plan. Epidurals offer pain relief. Again difficult to find cumulative numbers, administration of these drugs may be extremely high in hospitals all over the modern world. The CDC’s National Vital Statistics Reports 59(5), reported 2008 epidural statistics of 61% in single vaginal deliveries and 100% of C-sections in 27 states.^[12] These figures do not include twin and triplet births. The internet is rife with examples of women being told that their hospital’s epidural rate is 80 or 90 percent,.”Perhaps the recognized epidural rate in the United States should be revised to a number closer to 75%.”^[13]

The epidural catheter requires a high level of technical proficiency to avoid serious complications. Mom is required to sit or lie, rounding her back. The needle tip enters her low back, passing along a shelf of vertebral bone called the lamina. It enters the extremely dense ligamentum flavum. Pushing the needle into the ligament finally causes a puncture, which is signaled by a sensation of release for the anesthetist. He or she has to be vigilant to correctly aim the needle inside the spinal canal in order to avoid cord damage.

A catheter is thread through the needle and remains inside mom’s back, 4-6 cm deep. The liquid drug is fed into the catheter and rushes to fill the epidural space.  The following excerpts from AmericanPregnancy.com further explains how the slippery slope unfolds:

“You will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop…You might experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating…While in-utero, a baby might also become lethargic and have trouble getting into position for delivery…You might find that your epidural makes pushing more difficult and additional interventions such as Pitocin, forceps, vacuum extraction or cesarean might become necessary”^[14]

 

Five: Cesarean Section

In the midst of artificially-hurried Pitocin contractions and an epidural-induced numbing, mom loses much control over the birthing process. A numb mom feels less pain, but this lack of feeling can make it difficult for her to sense how and when to push. Her movements are off and she is less able to shift in ways that her body and baby were encouraging before. The mom with epidural numbness is a mom less able to help her baby down the birth canal. Her path for C-section has been carved.

 

Exercise Can Stop the Cycle

This sequence of events can be stopped before drugs and surgery take over. The research presented by Dr. Clapp in Exercising Through Your Pregnancy, makes it very clear:

First, moms who exercise spend less time in labor, minimizing the race against the clock.^[15] Second, moms who have exercised handle the physical challenge of labor better, reducing exhaustion by 75%.^[16] Third, exercise cuts the use of Pitocin by half.^[17] Fourth, exercise reduces a mom’s need for epidural pain relief by 35%.^[18] In all, exercise drops the chance of C-section 75 percent.^[19]

These are incredibly compelling evidence-based facts for anyone who desires to avoid an unnecessary C-Section, or help others avoid one. As always, remember that there are times when a C-section is medically necessary for the health and safety of mom and/or baby. This research is meant to help you and your clients make informed decisions when creating a birth plan.

^[20]

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