April is Cesarean Awareness Month

(Allow me to put on my PSA hat…)

Cesareans are wonderful live-saving tools when they are medically indicated.  But many women are unwittingly led–or even coerced–into unnecessary cesareans each year.  What’s more, these surgical procedures carry with them a variety of serious risks—risks often downplayed or obscured by the doctors who routinely perform unnecessary cesareans. 

This is part of the reason why birth activists across the county have made the effort to declare April “Cesarean Awareness Month.”  

Organizations such as ICAN (the International Cesarean Awareness Network) have worked tirelessly not only to educate women about cesareans and cesarean recovery but also to advocate for VBAC, or vaginal birth after cesarean.  The ICAN White Papers include a great list articulating the “Things You Can Do to Avoid an Unnecessary Cesarean.”  I’ve copied this list below, along with some editorializing and resource suggestions of my own.

Enjoy!

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ICAN’s “THINGS YOU CAN TO DO AVOID AN UNNECESSARY CESAREAN”

The Public Citizen Health Research Group in Washington, D.C. has estimated that half of the nearly 1 million cesareans performed every year are medically unnecessary. With more appropriate care during pregnancy, labor, and delivery, half of the cesareans could have been avoided. Clearly, there are times when cesareans are necessary. However, cesareans increase the risk to both mothers and babies. These are suggestions of things you can do to avoid an unnecessary cesarean and can help insure that your birth experience is as healthy and positive as possible.

BEFORE LABOR

• Read and educate yourself, attend classes and workshops inside and outside the hospital.  (My personal favorites include Ina May’s Guide to Childbirth by Ina May Gaskin, The Thinking Woman’s Guide to a Better Birth by Henci Goer, and Birthing from Within by Pam England.) 
• Research and prepare a birth plan. Discuss your birth plan with your midwife or doctor and submit copies to your hospital or birth center.
• Interview more than one care provider. Ask key questions and see how your probing influences their attitude. Are they defensive or are they pleased by your interest?
• Ask your care provider if there is a set time limit for labor and second stage pushing. See what s/he feels can interfere with the normal process of labor.
• Tour more than one birth facility. Note their differences and ask about their cesarean rate, VBAC protocol, etc.
• Become aware of your rights as a pregnant woman.
• Find a labor support person. Interview more than one. A recent medical journal article showed that labor support can significantly reduce the risk of cesarean.
• Help ensure a healthy baby and mother by eating a well-balanced diet.
• If your baby is breech, ask your care provider about exercises to turn the baby, external version (turning the baby with hands), and vaginal breech delivery. You may want to seek a second opinion.
• If you had a cesarean, seriously consider VBAC. According to the American College of Obstetricians & Gynecologist, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of woman with prior cesareans can go on to birth their subsequent babies vaginally.

 

DURING LABOR

• Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you.
• Continue to eat and drink lightly, especially during early labor, to provide energy.
• Avoid pitocin augmentation for a slow labor.  As an alternative, you may want to try nipple stimulation.  (You can also try acupressure before and/or during labor in order to stimulate contractions.)
• If your bag of water breaks, don’t let anyone do a vaginal examination unless medically indicated for a specific reason. The risk of infection increases with each examination. Discuss with your care provider how to monitor for signs of infection.
• Request intermittent electronic fetal monitoring or the use of a fetoscope. Medical research has shown that continuous electronic fetal monitoring can increase the risk of cesarean without related improvement in outcome for the baby.
• Avoid using an epidural. Medical research has shown that epidurals can slow down labor and cause complications for the mother and baby. If you do have an epidural and have trouble pushing, ask to take a break from pushing until the epidural has worn off some and then resume pushing.
• Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the hospital, instead of being admitted, walk around the hospital or go home and rest.
• Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on you and your baby, and what are your other options.
• Remember, nothing is absolute. If you have doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.