C-sections are becoming more and more common. In fact, in the United States, the C-Section rate is just above 32%. While listening to women’s stories on our VBAC podcast week after week, we notice a clear trend in the reasons for C-sections.
Most reasons for C-sections fit into a few categories. Some are necessary, and some may have been avoided.
As birth workers and educators, we encourage people to learn about all their birth options and choose given their situation. Vaginal birth vs. C-section isn’t always a choice, and some people desire elective C-section.
However, many parents desire a vaginal birth and want to know what they can do to prevent C-section from becoming necessary.
So, let’s walk through the primary reasons for C-section, and provide you with critical need-to-know information to help you avoid an unnecessary Cesarean.
Can you prevent C-section?
There are situations where performing a C-Section is necessary, and even life-saving, for mothers and babies. We are so grateful that we have the option. We also understand that sometimes a planned C-Section or family-centered C-Section is desired and that is okay, too.
Although it is hard to know what will happen during birth, there are things we can do along the way to help prevent a C-section. Preventing a C-Section can sometimes feel like a daunting task, since birth can be unpredictable. However, learning about the birth process will help you work with the factors you can control during pregnancy, labor, and birth, to have the best chances of avoiding C-section.
Today, we want to talk more about how to prevent C-section, and what reasons call for C-Sections.
What are the reasons for a C-section?
There are many situations in which a C-Section may need to happen, but as we mentioned above, there seem to be a few “main reasons” parents hear when their providers recommend C-section.
If you’ve had a C-Section before, it is helpful to discuss it with your provider, so you can better prepare for your next birth.
Failure to progress in labor
Historically, evidence has shown that many care providers do not give women the chance to progress in the first stage of labor (dilated to 10 cm) or enough time to push the baby out when they do get there.
In 2011, ACOG (American College of Obstetrics and Gynecology) and SMFM (the Society for Maternal-Fetal Medicine) put out an updated definition on time limits for the first and second stages (the pushing stage) of labor.
The new guideline says that a woman is not considered to be in active labor until six centimeters and cannot be termed as “failure to progress” until she is at least six centimeters dilated, her waters have ruptured, and no cervical change has been made in six hours of labor.
There are a number of factors that can lead to protracted labor, including scar tissue on the cervix. A mother’s emotional state and ability to cope with physical discomforts also plays into the body’s ability to labor effectively.
For the second stage of labor, there is no time limit for pushing the baby out and pushing can continue for up to three to four hours as long as mom and baby are stable.
Many women certainly had their primary Cesareans because their care provider did not give them enough time to labor or push.
Fetal heart problems
In a hospital setting, continuous fetal monitoring is often a requirement, especially for TOLAC (trial of labor after Cesarean), due to the risk of uterine rupture during VBAC. In about 70% of uterine rupture cases, EFM (external fetal monitoring) has picked up an abnormal heart rate pattern that can suggest separation of the scar (ACOG, 2017).
However, it is also normal for the heart rate to fluctuate outside of normal readings. A heart rate dropping several times or one that drops and doesn’t recover may be resolved by changing positions to adjust the baby’s position in relation to the cord.
Malpresentation or breech position
There are many things that can be done to ensure the baby is in a good position prior to labor starting and to get baby in a good position during labor. Issues like a transverse baby or shoulder dystocia can prevent you from giving vaginal birth successfully and avoiding C-section.
Movement and positions like getting on your hands and knees, squatting, not laboring on your back, and being mobile help significantly.
Your doula should have a rebozo that can work magic on a baby’s position. In 2018, ACOG released Committee Opinion 745 on breech presentation and it states:
“There is a trend in the United States to perform cesarean delivery for term singleton fetuses in a breech presentation. The number of practitioners with the skills and experience to perform vaginal breech delivery has decreased. The decision regarding the mode of delivery should consider patient wishes and the experience of the health care provider.
Obstetrician–gynecologists and other obstetric care providers should offer an external cephalic version as an alternative to planned cesarean for a woman who has a term singleton breech fetus, desires a planned vaginal delivery of a vertex-presenting fetus, and has no contraindications.
External cephalic version should be attempted only in settings in which cesarean delivery services are readily available. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for eligibility and labor management.
If a vaginal breech delivery is planned, a detailed informed consent should be documented—including risks that perinatal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned.”
Check out our post on how to turn a breech baby for eight methods you can use to reverse their position safely before you go into labor.
Big baby or small pelvis
By now you should already know how we feel about this. If your doctor has diagnosed you with a pelvis that is too small, CPD (Cephalopelvic Disproportion), or told you that your baby is too big, learn about your options!
If a big baby or small pelvis alone is the reason your provider suggests a C-section, it might be time to find a new provider who practices evidence-based care. A TRUE diagnosis of CPD and a baby that is REALLY too big for vaginal birth are incredibly rare and unlikely in healthy women with no history of trauma to the pelvic area.
Placenta Previa or Accreta
Placenta Previa is a condition in which your placenta has covered the cervix. With Placenta Accreta, the placenta has grown very deep into the uterine wall, which can happen in a previous C-Section scar.
These situations often require a C-Section. If this was a reason for a previous C-Section, it does not mean you will need to have another for future pregnancies.
How to prevent a C-section
No one can actually control everything that happens in birth. However, there are things we can do as individuals to enhance our chances of avoiding a C-Section.
You being here right now, learning about the reasons for C-section is one of the best things you can do to help prevent a C-Section for any upcoming births. Educating yourself is so important.
I always tell my doula clients that education is power in their pockets. You can never get enough education, and it will lead to a more empowering birth experience, regardless of how the birth happens.
The hardest part is knowing which information to trust. We created an online VBAC course where you can dive right into all the evidence-based information on both VBAC and C-Section.
Here are a few things that you can do to give yourself the best chances of preventing a C-Section.
1. Educate yourself
Again, the best thing you can do is learn all that you can about supporting the natural birth process, and if you’ve had a previous C-section, learn the real VBAC Facts. There are many VBAC myths and it can be hard and overwhelming to decipher what is really factual or not.
2. Have a supportive birth team
Having a supportive team is so important to ensure you have the best possible birth experience.
Having a truly supportive VBAC provider, hiring a doula, and having a supportive partner or friend to help you through labor can truly make all the difference when it comes to not only the way your birth ends but your overall view of the experience.
3. Avoid induction if possible
I want to clarify that many vaginal births and successful VBACs began with induction. Induction does not rule out your chances of having a VBAC, but avoiding it can help reduce the chances of C-section.
Medical interventions may decrease your chances of a vaginal birth if your body is not ready or the baby is not responding well. Learn more about how medical induction may affect C-section rates in our discussion of the ARRIVE trial.
4. Trust your body and baby
As mothers, we understand how uncomfortable and miserable the last weeks and even months of pregnancy can be. I am here to tell you, it won’t last forever.
Hang in there. Being patient and allowing your body to bring your baby into the world when you’re both ready can really help your chances of avoiding a C-Section.
5. Prepare physically and mentally
Preparing your mind and body for birth is so important. Eating healthy food, staying hydrated, staying active, and taking a moment each day to prepare your mind for birth can really help you enter a healthy space when your little one decides to arrive.
These are just a few key things you can do to help prevent a C-Section. We cover these and a lot more tips to help you have a vaginal birth in how to have a successful VBAC.
Nervous about your upcoming VBAC? We can help.
Our How to VBAC: The Ultimate Course for Parents is a comprehensive online course that will teach you everything you need to know to deliver your new baby with confidence.