After 10 hours of labor, my doctor turned to me and said, “Time for a C-section.” Before I could say “Why?” or even “Huh?” I was carted off and cut up like a roast turkey while I lay there gritting my teeth and wondering: How did this happen?
While cesareans are often necessary to preserve the health of both mom and baby, stories abound of doctors being slash-happy to ward off malpractice suits or even just to get home in time for dinner. To this day, I ask myself if there’s anything I could have done to dodge my C-section, and it turns out there are plenty of ways to at least lower the odds. Here are 7 things moms can try to curb their risk of going under the knife.
Pick a doctor with a low C-section rate. First off, don’t be shy: Ask your OB/GYN about their C-section rate. Like a batting average, it will give you a sense of whether a cesarean may be in your future, too. While 33 percent of births nationwide end up C-sections, the frequency for a particular physician can range way above or below that. “For a healthy woman with a single pregnancy past 37 weeks, you’d like to see that rate around 15 percent,” says Robert Atlas, M.D., an OB/GYN at Mercy Medical Center in Rockville Center, New York, who’s studied C-section for the past 10 years and acts as “C-section police” at his hospital, making sure the procedure is truly necessary. And since your primary provider may not be on shift the day your baby arrives, “find out the C-section rate of her call group as a whole,” adds Linda Rice, a certified nurse midwife at Harvard Vanguard in Chelmsford, Massachusetts. “Clinicians with higher C-section rates aren’t necessarily bad doctors, but are usually just more conservative and will usually be forthcoming about where they lie on that spectrum.” If a doctor hems and haws about his answer, that’s a red flag he has something to hide.
Or choose a midwife instead. Although midwives handle only 8 percent of all births, they boast lower C-section rates across the board compared to those overseen by doctors, hovering around 3 to 4 percent. Why? Midwives don’t perform C-sections, although they can call for one if necessary. The difference is they just don’t think they’re necessary as often as doctors do. This is due to their training, says Bruce Flamm, M.D., an obstetrician at Kaiser Permanente Medical Center in Riverside, California. Midwives are taught to “see labor as physiology,” he explains. “We OBs are trained to see labor as a disaster waiting to happen.”
Hire a doula. Doulas attend only 1 percent of births, yet studies show their presence lowers the odds of C-section by 40 percent. A doula doesn’t deliver the baby; she’s just there to ensure the delivery happens the way the mom wants, making suggestions and advocating on her behalf in case the mom is too distracted or delirious to make these decisions herself. “She may put the mother in the best positions for her and the baby and suggest the right questions once an OB would suggest a C-section,” says Stephanie Heintzeler, a doula in New York, New York.
Don’t get induced. “Induction increases the odds of a cesarean to 40 percent,” says Dr. Atlas. “The reason is if the cervix is not ready, you’re forcing a process that might not be ready to be forced.” So unless an induction is medically necessary, try to hold off until 41 weeks, one week after your official due date. After that point a baby’s health begins to be compromised; by 42 weeks an induction is par for the course since your placenta stops working well enough to keep your baby healthy.
Labor at home as long as possible. Traditionally hospitals admit women who are at least four centimeters dilated. But new research suggests most women can wait at home until six centimeters — and that this could lower C-section rates. The reason: As soon as you set foot in a hospital, you could be exposed to a range of medical interventions that could slow down your birth and pave the way toward a cesarean. “Early interventions confuse the body in labor and things don’t progress,” says Heintzeler. “The more interventions the mother has — like an epidural or Pitocin — the more likely she will have a C-section.” Even just being stuck in a bed hooked up to an IV and fetal monitor can throw a wrench in things. “Being up and not tethered to monitors or IVs is not only more comfortable but can help your body proceed through labor normally,” says Rice.
Know that the “standard” labor rate is outdated. One of the first lessons OB/GYNs learn in med school is Friedman’s Curve, based on a researcher who found that women’s “active” labor (past four centimeters) progresses at about one centimeter per hour. Anything slower was deemed “failure to progress” and a prime C-section candidate. The problem? This research dates back to 1955, and a lot has changed since then that makes this benchmark obsolete. For instance, most of Friedman’s study subjects were sedated, and younger, and slimmer than women are now — all of which makes his curve ideal rather than average. Yet many hospitals still use it as their yardstick to determine whether a C-section is merited. Bottom line: Don’t let anyone tell you you’re not “progressing fast enough.” Also keep in mind that “hospitals are in the business of moving things along,” points out Debi Tracy, a certified childbirth educator in Oceanside, New York. “So if you’re sitting there and not progressing, it’s very likely they’ll make suggestions to speed things up, often to benefit their bottom line, not to the benefit of the child or mom.”
If your doc recommends a C-section, ask these questions first. “I have three questions I give my clients to ask their OB if a C-section is suggested,” says Heintzeler. “Those questions are: 1) Is my baby okay, is there any danger at this point? 2) Am I okay? 3) Can we please wait? If an OB agrees to wait, it shows there is no urgency, just impatience. Sometimes they will be like, ‘Well, we can wait but things will probably look the same in one to two hours, so why not do the C-section right now?’ Yet if we wait those one to two hours, most likely a C-section can be avoided, and if not, the mother knows she did everything she could and had enough time. She will feel more in control, that’s the key.”