by Stephanie Emfinger, CD (CBI)
Chapter Co-Leader

Happy Cesarean Awareness Month, everyone! That’s right--April is Cesarean Awareness Month. In honor of the occasion, the Wiregrass Birth Network’s April meetings will be focusing on c-sections, vaginal births after c-sections, and Dothan’s new chapter of the International Cesarean Awareness Network (ICAN) with leader Amanda Martin.

We all agree that the cesarean rate is too high--way higher than the World Health Organization’s recommendation of 10-15%. In 2008, 35.5% of all births were by a cesarean, and the Wiregrass’s main hospitals rates were even higher! More than one out of every three women giving birth in our area will give birth by an abdominal surgery. That is a scary number! So what can a mother do to lower her risks?

First, you have to educate yourself. You can do this by attending Birth Network and ICAN meetings, talking to other moms about their births and common scare tactics used by area doctors, and reading good books about birth and how birth interventions increase your risk of cesarean delivery. Ask your Birth Network co-leaders for a list of good books that they recommend, and let them know if you need more information on a particular topic.

Secondly, you have to set yourself up for success. You need to find a birth situation that works for you, including a birth attendant that will respect your wishes instead of putting your through the system of medical obstetrics. You also need to realize your own role in your birth outcome. It takes courage and a sense of consumer responsibility to stand up to a doctor’s advice or a hospital’s protocol when you know their information is wrong and you feel educated enough to be confident in your decision. A mother can always refuse any drug, procedure, or protocol; and no one can make you do anything if you refuse. If they do, they can be slapped in jail with assault charges! It is your body, your baby, and your right to tell the nurse or doctor that you are giving your informed refusal.

Thirdly, you need to prepare yourself physically. Giving birth is an athletic event, and a body that is not prepared cannot perform as well as it should. Physical preparation for birth includes eating right, exercising, and practicing optimal fetal positioning. Eating a varied and balanced diet is important during pregnancy to prevent pregnancy complications caused by poor diet and to give your muscles all the nutrients they need to perform during labor. Also, good nutrition does not stop when labor starts! A mother needs to stay hydrated and well-fueled during labor to prevent exhaustion.

Regular exercise is also a must during pregnancy. Exercise increases your body’s stamina and overall fitness--training your cardiovascular system, your respiratory system, and even your mental stamina to be able to “stay with it” and keep going during the rough parts of regular exercise and of labor. Walking, swimming, and prenatal yoga are some of the best exercises you can do during pregnancy.

Likewise, practicing Optimal Fetal Positioning (OFP) before and during labor can help prepare yourself physically by getting the baby into a good position for birth. Practicing OFP includes anything that helps put the baby in the best position for birth--head down, chin to chest, and nose to the mother’s back. Some OFP exercises are sitting on a birth ball or on the floor cross-legged, practicing pelvic rocks daily to encourage the baby up and out of the pelvis and into a good position, frequently sitting in good postures with the belly flowing forward and the spine straight, and avoiding couches or chairs that encourage slouching or rounding of the back.

Using mindful labor positions is also a part of OFP. In labor, keep your belly button always pointing down--whether you stand, sit, lie on your side, or use all-fours positions. This gives baby lots of room to rotate properly. Stay off your back during labor because back-lying can take away room from the baby and can cause the baby to have to be pushed against gravity during each contraction as your body tries to align the baby’s head through your pelvic opening. You can also use the lift and tuck, the belly dump, or the rebozo technique illustrated on the Spinning Babies website.  More information on OFP can be found on Amy Hoyt’s blog.

And lastly, along with educating herself, setting herself up for success, and preparing herself physically, a mother needs to be aware that many times a cesarean can be recommended even if there is no true medical reason. Absolute medical reasons for c-sections include a transverse lie (the baby is lying horizontally in the pelvis), a prolapsed umbilical cord (the cord comes down before the baby), and a placenta that separates before the birth (called “placenta abruptio”) or partially or completely covers the cervix (called “placenta previa”). Maternal medical conditions can sometimes demand the early birth of the baby, too; these include severe hypertension, diabetes, and true cephalopelvic disproportion.

But are these the only reasons c-sections are preformed? Not hardly! All kinds of reasons are given to mothers to make them think they need a surgical delivery. Common reasons include “failure to progress”, maternal exhaustion, convenience for mom or doctor, breech presentation, misdiagnosing cephalopelvic disproportion, and fetal distress. Some of these reasons are quite controversial as to whether or not they require a cesarean.

For example, a diagnoses of “failure to progress” could mean that the baby and the mother just need more time; often, the mother and baby are progressing, but mother might not be dilating fast enough to keep everyone else from getting nervous. Mommies and babies need lots of time in labor--time to rotate into a good position, time to let the mother’s birth hormones catch up with her progress in labor, time for immunities to build up in the mother’s colostrum, and time for mother and baby to mentally let go and give in to their labor.

Likewise, some of the other diagnoses that recommend a cesarean are not true medical emergencies. Breech babies can be delivered vaginally if the right conditions are met; they can also be turned using a lot of different methods: the Webster technique of chiropractic care, acupuncture, moxibustion, homeopathic remedies like pulsatilla, or an external version. Cephalopelvic disproportion can easily be misdiagnosed based on ultrasound measurements; but your pelvis loosens and expands during labor just as the baby’s head molds and conforms during labor! And lastly, continuous fetal monitoring can cause over-diagnoses of fetal distress, increasing the risk of a cesarean section without producing better outcomes for mom or baby.

With fears of malpractice suits and litigation increasing among doctors, it is often safer for the doctor’s protection to perform a surgical delivery than to let a mother continue attempting a vaginal delivery; but you can get the information you need before you consent to or refuse any procedure, including a c-section, by asking “B-R-A-N-D”. Ask your healthcare provider, “What are the Benefits? What are the Risks? What are the Alternatives? What if we do Nothing? What if we Delay?” It might not be a true emergency if the doctor or midwife has time to get you to sign a bunch of paperwork, watch an informed consent video, and get prepped for surgery. If the baby is okay and if the mom are okay, feel free to ask for more time so you can avoid being pressured into making a hasty decision.

Armed with these tips of educating yourself, setting yourself up for success, and preparing your body and your baby, you will be able to lower your risks of a cesarean delivery. Happy Birthing!