(Tips to Avoid) Cesarean Delivery 
 
According to legend, Julius Caesar was born surgically, thus lending his name to the well-known practice of Cesarean section or C-section for short. In this past, this was done for a truly life saving purpose for the mom or baby. Fortunately, today’s modern C-section techniques are safer, but when do you really need one? At OBGYN North, our midwives and physicians strive to avoid c-sections unless medically necessary. We invite all mothers to be proactive throughout pregnancy by maintenance of a healthy weight, healthy diet, exercise, and childbirth preparation.
 
The national C-section rate is nearly 1 in 3 births.  At OBGYN North, we think this is too high of a number.  Our practice average is about 1 in 5, including planned repeat C-sections. For a first time c-section our rate is 1 in 7. Additionally, we are excited to support women with vaginal birth after C-section, known as VBAC with one or two prior cesarean deliveries. After obtaining the documentation of your previous cesarean scar(s), we provide consultation with our physicians to help you determine if this is a good option for you. (This is not common at many other practices). Our VBAC success rate is over 80%!
 
How is this possible? At OBGYN North, we will do our best to help you avoid a C-section. This blog post will focus on how we as a team (midwives, doctors, mothers-to-be, and their support team) help avoid this surgery.  
 
A common reason for a C-section is dysfunctional labor or failure to progress. One of the common reasons for a failure to progress is the result of induction of labor when the body is not ready. For this reason, we induce only for medical indications (fetal or maternal health risks). It is best to allow moms to labor without intervention when none is needed. To avoid a medical induction of labor we may suggest herbals, ambulation, nipple stimulation, and encouraging doula support of your labor. Should induction be medically necessary, we will walk you through the process and proceed slowly as the body intended helping you get into labor.
 
Labor preparation is also very important. We offer many options for preparation classes so that you will find one that fits your personality and philosophy of labor best. Our physicians and midwives want to help support your birth plan; therefore, we recommend discussing all your pain management options with your providers.  Epidurals are safe, but sometimes they slow the normal labor process. We have other options available.
 
Our next most common reason for a C-section is a breech delivery (baby’s head not turned down). Our strategy to avoid this outcome is to identify the position of the baby early. Your assistance is important here: such as identifying where the baby is kicking and discussing any concerns to your providers during your visits. A quick ultrasound late in the third trimester can be very helpful as well.  Regular exercise, acupuncture, and the Webster technique (chiropractors typically perform this) are helpful to turn the baby’s head down. Spinningbabies.com is great resource for mothers with breech babies and other less optimal positions for labor. Finally, at 37 weeks, about 5% of babies are still breech. At this point, our physicians will offer to turn the baby head down.
 
The majority of pregnancies are healthy and normal, and do not need intervention.  Our mission is to support our moms through a safe pregnancy and delivery. Sometimes in labor, contractions lead to baby heart rate changes. This is probably the result of cord compression or a problem with the placenta. To help avoid placental problems, we recommend a healthy diet and regular exercise throughout pregnancy.   If it is an issue of cord compression, then we may ask you to change positions as you labor to help your baby maintain heart rate and get enough oxygen.  Some other methods to improve the baby’s situation include oxygenation, hydration, and an amnioinfusion (replace fluid around the baby). 
 
Unfortunately, there are times when C-sections are necessary for you and your baby.  If we can’t resolve one of the above issues like persistent breech positioning or if your baby still doesn’t tolerate labor, we may need to do a C-section. One other reason for a C-section may on occasion be a placenta previa (placenta over the cervix).  A suspected “large” baby is rarely an indication for a cesarean delivery in a low risk mother. If we are recommending a cesarean section, then we will counsel and involve you in the decision making process. If you are having a scheduled C-section, we can offer a family-centered (otheriwse known as a gentle C-section). See this link for more information.  
 
If we recommend a C-section, please know it is after we have exhausted all our other options.  Our physician midwife team will work together to help your birth experience to be a joyous occasion. At OBGYN North from the time of your pre-conception visit throughout your pregnancy, we strive to offer the highest quality pre-natal care. By doing so, we can reduce your risk of C-section and avoid unnecessary labor interventions. We want to encourage moms’-to-be and their family’s participation throughout the process, leading to a healthy and happy outcome for you, your baby, and your whole family.
 
Best wishes for a happy and healthy labor! 
April Schiemenz, MD