Nearly every expectant mother envisions herself experiencing a peaceful, natural birth without complications or undue discomfort. While this is the ideal everyone strives for, it sometimes does not occur. The truth is that currently in the US, nearly one third of all deliveries are by cesarean section. This compares to a worldwide C-section average of 19% (statsnews.com). The reasons for this discrepancy are varied and occasionally controversial.
Your health needs and those of your baby affect whether you will have a C-section or vaginal birth, but other things may also affect the decision. These things include:
Your choice of birth setting and care provider. C-section rates can vary greatly from one birth setting to another. And differing policies and practices between care providers also vary widely.
Your supportive care during labor. Having strong, informed support persons present will enable a laboring mother to remain focused and allow for adequate communication with all care providers. Having a doula can help you get through a long and challenging labor. A strong support person can also help your spouse or partner help you. Such care lowers the likelihood that you will have a cesarean birth.
Any medical interventions during labor and delivery.
Depending on the circumstances, a C-section may also be suggested as an option if:
Your labor is taking a long time. You may be told you have “prolonged labor” or that you are “failing to progress.” Again, having a strong support team can assist you through a lengthy labor. Additionally, recent professional recommendations indicate more patience and time allotment for labor than in the past.
Baby is in a breech (buttocks or feet-first) position. Some care providers are trained to use external version (hands on your belly) to turn a baby during the last weeks of pregnancy. While this technique does not always work, it often does and can lower your likelihood of needing a C-section.
There are changes in the fetal heart rate. Most hospitals use electronic fetal monitoring (EFM) to track a baby’s heart rate. However, electronic fetal monitoring can falsely suggest that the baby is in trouble, so further testing can help show if your baby needs help.
Previous C-section (discussed below)
Research suggests the following also reduce your chances of having a cesarean birth:
Choosing a care giver and birth setting with relatively low cesarean rates
Working with care provider to delay hospital admission until labor is well underway.
Using periodic listening with various devices to monitor fetal heart patterns rather than continuous electronic fetal monitoring during labor.
Staying upright and moving around in labor before the pushing phase.
One of the most common reasons a C-section is recommended is if you have had a previous birth via C-section. Care providers are often in disagreement on how to handle this situation. Some recommend planning a VBAC (vaginal birth after cesarean). Others recommend scheduling another C-section. Your best option is to seek care that matches your goals.
While sometimes caregivers are influenced by insurance company restrictions or convenience of scheduled deliveries, the biggest concern caregivers have regarding VBAC is the possibility of uterine rupture caused by the previous C-section scar giving way during labor. However, current research shows that 60% to 80% of women with positive supportive care who plan VBAC do successfully deliver vaginally.
Each additional C-section increases the amount of internal scar tissue which can make it increasingly difficult for the placenta to attach and grow normally. This can be a risk to both baby and mother. More scar tissue can also increase the incidence of adhesions (where nearby tissue or organs grow together). Such adhesions also make future C-sections more difficult and risky in any future pregnancies. A VBAC in your current pregnancy means less scar tissue and adhesions in the future. This means a lesser chance of previous C-section scar rupture and a greater chance for successful vaginal delivery.
As always, the ultimate goal is a healthy baby and mother. The best way to ensure this goal is to educate yourself to all birth options available to you.
The following websites offer valuable information on both C-section and VBAC: