How to Avoid a C-Section Procedure

Consumer Reports/ April 13, 2016
Picked up from Yahoo News

A third of babies born in the U.S. are delivered by cesarean section, and researchers estimate that about half of those surgeries are medically unnecessary.

A number of hospitals have taken steps to reduce the number of C-section procedures. For example, the 30 hospitals across the country that are affiliated with the Kaiser Permanente healthcare system, most of them in California, have an average C-section rate of 22 percent for low-risk deliveries, which is below the national target. Kaiser tends to do well in part because its structure allows it to identify best practices, and then quickly spread them to all of its facilities, says Tracy Flanagan, M.D., a board-certified obstetrician-gynecologist and director of women's health with Kaiser. Those practices include staffing the labor and delivery floors with certified nurse-midwives, and establishing standards for how to interpret electronic fetal monitoring.

And lowering C-section rates can take years of hard work, according to Robert Silverman, M.D., chief of the Department of Obstetrics and Gynecology at Crouse Hospital in Syracuse, N.Y. His hospital had the lowest C-section rate for low-risk pregnancies in our Ratings among facilities with at least 3,500 births, at just 11 percent. "We have spent literally decades on educating the physicians at our institution about really good prenatal care," Silverman says. "Everything we can do to prevent that first C section from occurring, we try to do."

Since it can take so long time for hospitals to change their approach to childbirth, it may be up to you to reduce your risk of having a C-section procedure. Here are some steps you can take.

1. Find Out Your Hospital’s C-Section Rate

Start with our hospital Ratings. If your hospital is not included, ask the person who will deliver your baby about the hospital’s rates. A hospital’s C-section rate for low-risk deliveries for first-time moms should be below 23.9 percent. If your hospital does not publicly report its data, ask why—and ask what their rate is. If they don't tell you, consider going to another hospital. Note that some hospitals may have low C-section rates because they transfer women at higher risk to other hospitals, so ask the hospital how they handle such patients.

2. Choose Your Provider Carefully

It’s good to know the C-section rates for your doctor, too, so ask whether his or her practice tracks their C-section procedures. “Even if they don’t know the exact percent, providers should be able to articulate their philosophy about supporting vaginal birth,” Caughey said. Also ask how the new guidelines may affect the practice’s approach to labor and delivery. If your provider is unaware of the new standards, or is dismissive of them, you may want to find a different one.

3. Consider a Midwife

Women with low-to-moderate-risk pregnancies can consider using a nurse midwife as a primary care provider. Midwives stay with women throughout labor and do not do surgery, so they only transfer a woman to an obstetrician’s care when C-section is medically necessary or serious complications arise, says Amy Romano, a certified nurse midwife (C.N.M.) who formerly taught midwifery at the Yale School of Nursing and is currently senior vice president of clinical programs for Baby+Company, a network of midwife-led maternity clinics based in North Carolina.

4. Watch Your Weight

If you are overweight, strive to shed excess pounds before becoming pregnant. Overweight and obese women have a much higher risk of having a C-section procedure than normal weight women. And once you’re pregnant, talk with your provider about what is a healthy weight gain for you. Women who are overweight should plan to gain less than those who are not.

5. Stay Fit

Women who take part in structured exercise during pregnancy are less likely to need a C-section procedure, research suggests. Talk to your healthcare provider about appropriate forms of exercise, such as walking, swimming, and aerobic or yoga classes for pregnant women.

6. Don't Rush

Doctors should not try to induce labor unless there’s a good medical reason—for example, if a woman’s membranes rupture (her “water breaks”) and labor doesn’t start on its own or she is a week or more past her due date. Trying to induce labor before a woman’s body is ready can lead to surgical delivery if labor doesn’t progress.

---

More on Pregnancy and Childbirth

Childbirth: What to Reject When You're Expecting
Your Biggest C-Section Risk May Be Your Hospital
Preparing for Pregnancy: What to Do Right NowNearing Your Due Date: Plan for Your Baby's ArrivalGiving Birth: What to Do Right Away
What to Do If You Need a Cesarean Section
Having a Baby in CaliforniaThe Safest Strollers, Car Seats, Cribs, High Chairs, and Other Baby Products

---

7. Don't Worry Too Much About Big Babies

The possibility of a large baby is frequently used to justify a cesarean delivery, but that’s not warranted, according to the new ACOG/SMFM guidelines. To begin with, methods used to assess the baby’s weight toward the end of the pregnancy are not very accurate. Also, babies typically have to be 11 pounds or larger to justify a cesarean, according to Caughey.

8. Get Support During Labor

Consider hiring a doula, a trained birth assistant who can provide physical and emotional support throughout labor and delivery. Women who have continuous support from someone who is not a friend, family member, or a member of the hospital staff labor for shorter periods and are less likely to need interventions, research shows. Ask your insurer if it will cover doula care.

9. Ignore the Clock

The new guidelines call for allowing more time in each phase of labor and delivery. In general, decisions on whether to intervene should be based on how well mothers and babies are doing, not how much time has passed.

Editor's Note: This report is supported in part by the California HealthCare Foundation, based in Oakland, Calif.