There are lots of reasons for having a Cesarean birth. Some C-sections are due to circumstances that are discovered during labor such as failure for labor to progress, disproportionate sizing between the baby’s head and the pelvis, and abnormal fetal heart rate. Others are planned or scheduled due to conditions that were exposed during pregnancy including breech position, multiple pregnancy (e.g. twins), and placenta previa. In very rare instances, Cesareans are performed because of emergency situations such as cord prolapse or placental abruption. Occasionally, women opt for a Cesarean delivery for personal reasons even when there is no medical indication for having one. The question that remains, however, is what proportion of the 30% Cesarean rate is influenced by perceived “benefits” to the physician such as shortening the length of labor and financial incentives?
The unplanned Cesareans that occur because of issues that arise during labor allow for more subjective assessment than those in the planned, emergency and elective categories. In a recent report, Physicians Treating Physicians: Information and Incentives in Childbirth, economists Erin Johnson and M. Marit Rehavi presented findings potentially related to such subjectivity: patients that were physicians were 10% less likely to receive a Cesarean compared to non-physician patients. Because obstetricians in many hospital settings are paid more for Cesareans, there appears to be an interaction between financial incentive and patient knowledge as factors in the obstetrician’s decision-making. As described in NPR’s report on Johnson’s and Rehavi’s paper, money may be subconsciously or consciously motivating some obstetricians to perform Cesareans on patients that have lesser understanding of the indications for surgical intervention during labor. They also found that patients that were physicians had better health outcomes, “suggesting overuse of C-sections adversely impacts patient health.”
So, as a patient, what can you do to decrease your chances of having a Cesarean?
Below are 10 Tips to help you achieve that goal:
- Eat healthy food and exercise routinely – stretching and strengthening exercises such as prenatal yoga are especially helpful in preparing your body for the positions of labor.
- Take an evidence-based childbirth education class to learn about your options including indications, risks and benefits related to Cesarean birth.
- Discuss your birth preferences with your doctor or midwife during your prenatal visits.
- Avoid electing to have an induction or Cesarean for non-medical reasons.
- Consider interviewing and hiring a doula for labor support.
- Stay at home during early labor.
- Have ample support from your birth partner, support person(s) or doula while laboring and pushing.
- Change positions every 20 – 30 minutes when possible and use gravity to your advantage with upright and forward leaning positions during labor and pushing.
- Delay the use of an epidural so you have the option to engage in all positions, including out of bed options.
- If your doctor or midwife recommends a medical procedure, including Cesarean delivery, ask about risks, benefits, possible alternatives and any other questions you may have. Find out if the situation is urgent or if there is opportunity to allow more time before deciding.
Cesarean birth is sometimes medically necessary and always a reassuring option when a situation requires such intervention; however, Cesarean rates have increased over time without leading to improvement in outcomes. It is time to reassess this increase and the best place to start is to augment your own knowledge so you feel confident in contributing to the decisions involved with your pregnancy, labor and birth.
Chris Just, RN, MSN, CNM