How To Avoid The Avoidable Cesarean

16 Jul

If you are expecting and planning to labor and give birth in a hospital, you may want to find out about outdated care practices that are likely to increase your odds for a cesarean. Knowing about them and discussing them with your caregiver during your pregnancy will help you to avoid unnecessary complications that can lead to the need for a cesarean that could have been avoided.

Maternity care experts found that, “ Current obstetric care in the United States remains distinctly different from the rest of the world, applying a high-risk model to all women and overusing costly procedures that increase risk.” That includes the overuse of cesareans for low-risk mothers-mothers that should have had a normal birth.

In addition to looking for a hospital with low-cesarean rates with midwives as well as physicians on staff,  knowing about these evidence-based practices will give you the best chance of having a vaginal birth.

Portrait of stressed young woman in bathtub

Your labor is more likely to progress normally if you are admitted to the hospital with regular painful contractions. When your cervix is effaced 80% or more and dilated 4 to 5 centimeters. If you are admitted to the labor and delivery unit too early (at 3 to 4 centimeters dilation) you are likely to have more interventions, twice as likely to be given oxytocin to speed up your labor, and more likely to have a cesarean. Find out more from Lamaze International about what to expect in early labor and how to make yourself comfortable until it’s time to head to the hospital.

Intermittent auscultation, checking your baby’s heartbeat at certain times during labor and birth, is the preferred method of monitoring labor for low-risk women. If you have had a healthy pregnancy and go into labor at term, continuous electronic fetal monitoring (EFM) can increase your risk for a cesarean. Although many hospitals routinely use continuous EFM, this intervention offers no benefit to your unborn baby nor does it improve your health. In addition, EFM restricts your movements. It denies you the ability to walk, change positions, take a shower, or use a tub for pain relief. Women who have freedom of movement during labor, are upright and walk during labor have fewer cesareans. Labor can be monitored intermittently with a hand-held device such as a fetal Doppler. Intermittent monitoring is usually a better choice.

Avoid a routine early amniotomy (breaking the bag of waters) before 5 cm. Many caregivers break the bag of waters during labor. Doing so removes the cushion of the forewaters that can help the baby rotate during labor to a favorable position for birth. Breaking the bag of waters may result in non-reassuring FHR patterns (fetal distress) that can lead to a cesarean.

New guidelines now consider that women are in active labor at 6cm dilation, not 4 cm as previously thought. That is the phase of labor when the fastest rate of dilation begins. Evidence shows that to progress from 4cm to 6cm takes longer than we previously assumed. It may take more than 6 hours to progress from 4 to 5cm, and more than 3 hours to progress from 5 to 6cm. If you are laboring for the first time it may take up to 20 hours to reach 6cm dilation and up to 14 hours if you have labored before. That means that your caregiver should not recommend a cesarean for “failure to progress” before 6cm.

Caregivers often call for a cesarean too early in labor. If a cesarean is recommended for labor that is “too slow” or for “ arrested labor,” you should be at 6cm dilation, with a broken bag of waters, and have labored for 4 hours with adequate contractions without any cervical change. All three conditions must be present before a cesarean can be considered for “failure to progress.” If you were given oxytocin, at least 6 hours should have passed without cervical change before a cesarean is recommended. If you have an epidural during labor, change positions every 20 minutes to help the baby rotate to a favorable position for birth.

Allow for passive decent of the baby. Many mothers don’t feel the urge to push at 10cm dilation. The strong urge to push may come as long as two hours after full dilation. Mothers who wait for the urge to push tend to have a shorter pushing time and greater chance of a spontaneous birth.

Caregivers often call for a cesarean too early during the second stage (pushing phase) of labor. Before your caregiver recommends a cesarean for second stage arrest you should have tried to push for at least 3 hours if this is your first labor and for 2 hours if you are a mother who has labored before. If you continue to have an epidural during the pushing stage, you can push for up to 4 hours if this is your first labor and for up to 3 hours if you are an experienced mother as long as vital signs are normal for you and your baby. If you ask for the lowest dose of epidural analgesia, you are less likely to need an assisted birth with a vacuum or forceps and more likely to have a shorter pushing phase.

Although these evidence-based practices will give you the best chance to avoid the avoidable cesarean, many caregivers and hospitals have not yet made these changes in their practice guidelines. Take the time to talk to your care provider about them during your pregnancy and during your labor to help you have a normal birth.

 

One Response to “How To Avoid The Avoidable Cesarean”

  1. Alan Patterson MD FACOG September 11, 2016 at 3:31 am #

    If you are considering a VBAC make sure you are an appropriate candidate and make sure your health care provider has a 60=80% VBAC success rate or that provider is DOING inappropriate VBACS,(you should ask your health care provider what his or her’s success rate is) and not providing good medical care. Too may women are promised a successful VBAC when in reality if you look at their specific situation they have a very small chance of success and end up with a C-section after often times being in labor too long! And if you have a successful VBAC but end up with severe vaginal lacerations or a rectal tear that is far worse than having a repeat C-SECTION!

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