This blog was originally posted on April 9, 2019.
Cesarean Awareness Month was started by ICAN (International Cesarean Awareness Network) to shine a spotlight on the number of cesarean births in the United States. ICAN also wanted to bring attention to the lack of access women have to VBAC supportive medical care. In 2016 the cesarean rate in the U.S. was 31.9%, going down from 32% in 2015 but still not where we need to be. The WHO (World Health Organization) recommends a target of 10-15%. Research shows that most pregnant people want to deliver vaginally and half of the Cesareans performed are not medically necessary. So, what's up?
Being overweight, diabetic, or advanced maternal age can make it more likely for someone to have a Cesarean. However, many studies are pointing to the choice of birth place, specifically which hospital you choose that is responsible for your chances of an unnecessary Cesarean. Cesarean rates vary in each state and from one side of a state to another. You can check the cesarean rates at the hospitals near you or ask during your hospital tour. Your choice of medical provider can affect your chances too. Ask your medical provider what their cesarean rates are and if you don't like the answer or they don't want to tell you, switch providers. Low risk pregnancies are also good candidates for birthing at birth centers or at home. For some people it may not be possible to change birth location or medical providers but there are many other things you can do to reduce your chances of an unnecessary cesarean.
Staying home during early labor is one great way to avoid unnecessary interventions at the hospital that could lead to an unnecessary cesarean. Taking a childbirth class, reading books or hiring a doula can help you to know what to expect in early labor so you don't go to the hospital too soon. Depending on your distance to the hospital you can most likely stay home until your contractions are 3-4 minutes apart, one minute in duration, with that pattern lasting for one hour. This is sometimes referred to as 4-1-1 or 3-1-1. Talk to your care provider about what point you should head to the hospital. The longer you are at home, comfortable in your surroundings the more relaxed you may be which is great for labor progress.
If your due date has come and your are not in labor, that's OK too. Don't rush to induce just because you are past your due date. First timers, if left alone to go into labor naturally, are likely to be pregnant for about 40 weeks and 5 days. If it isn't your first rodeo, the average is around 40 weeks and 3 days until baby time. Due dates are an estimation date, not an expiration date. Some people go before their due date and some after, only 10% go past 42 weeks. Your body knows what it’s doing. Once things kick into gear you can expect that labor can be long, especially for first timers. You can educate yourself so you know how labor progresses so you can expect that it may take a while. If you are doing well, and baby is doing well and progress is being made, that's great! A low risk person with a progressing labor, even if its "slow" is no reason for medical interventions.
"You are so big!" is not a complement to those in their final weeks of pregnancy. It is also not a reason for a Cesarean. It is important for all people to eat healthy but for those pregnant proper diet and average weight gain is important to avoid complications. Pregnant people in the U.S. do gain more weight than is recommended by the Institute of Medicine (IOM). You are building a human and your body is working really hard and if you can keep it down, yes eat! The concern is excessive weight gain that can lead to complications and the increased risk of Cesarean. A big belly on you is not the only risk, a suspected big baby is also no reason for an induction and rarely for cesarean delivery. Just because your belly is as big as a beach ball doesn't mean your baby is huge. The methods used, including ultrasound, at the end of pregnancy are not accurate ways to determine baby's size. In my personal experience I have seen these guesses be incorrect. There have been cases where the guess was 2 lbs more than baby's birth weight!
Even if you have taken a childbirth class having a knowledgeable support person there with you during labor can make a real difference. A doula is a trained birth assistant who can provide physical and emotional support throughout labor and delivery. Research shows, people who have continuous support from someone who is not a friend, a family member, or hospital staff have shorter labors and are less likely to need interventions. As a doula and a momma I know the importance of support during that time.
Cesareans are major abdominal surgery and are definitely not the easy way out. The recovery time is 2-4 weeks longer than a vaginal birth and there are so many potential complications to a Cesarean delivery, damage to internal organs, blood clots, internal bleeding and infection to name a few. There is also a lower breastfeeding success rate for families of Cesarean birth. Some reasons for a Cesarean include, placenta previa, baby's position, multiple birth, Diabetes and uncontrolled high blood pressure. When a Cesarean is medically necessary it can save lives but many are not necessary. Educating yourself, knowing your options, making a good choice of provider and hospital are all ways you can avoid an unnecessary Cesarean.
If you do have a Cesarean its OK to feel however you feel about it. This blog and the idea of Cesarean Awareness Month are not to make anyone feel any one way about Cesareans. I have worked with families who needed a Cesarean, were happy with the outcome, support and hospital experience. Some families do choose to have subsequent Cesareans rather than VBAC. Your birth experience is just that, yours. It is the hope of this blog that some information can possibly help decrease some of the unnecessary Cesareans happening in the U.S.
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