Avoiding a caesarean

There are several things that you can try in an attempt to avoid a caesarean birth:

• Optimal foetal positioning - This is a simple and commonsense approach to help align your baby in the pelvis before labour begins. For example turning your baby out of a breech position can remove the need for a caesarean. The Active Birth Centre can offer a great deal of advice and support on this subject. You may also find the book Optimal Foetal Positioning by Jean Sutton useful. During labour, walking and not lying on your back (particularly during the second stage of labour) can also help maintain a good delivery position
• Hypnotherapy - This can offer you a remarkable degree of control over your mind and body. You may be able to reduce pain, fear, and anxiety whilst in labour, creating a calmer experience and a less stressed baby. Fear of hospitals, needles, panic attacks and clinical / ante-natal depression can create an unpleasant pregnancy and childbirth. Clinical hypnotherapy and psychotherapy can produce better coping skills and help to keep you in a birthing centre or at home thereby reducing the likelihood of medical intervention
• Knowing your rights - Means that you are more able to rationally discuss the need for the caesarean and this may help to prevent caesareans in cases that are exhibiting borderline medical indications. Knowing when to allow medical intervention to take over will help you maintain a feeling of control. For example in the UK "failure to progress" is NOT a sufficient reason to have a caesarean. You have the right to ask for further clarification if this is the only reason you are being given
• Induction - is thought to double the likelihood of a vaginal birth ending in a caesarean. "Induction may lead to a longer labor and overall hospital stay, more medical interventions, higher costs, risk of potential for litigation, and adverse outcome for a mother or baby."127 Be confident in the reasons you are being given for the need to induce. It should be more than simply "failure to progress". One reason commonly given is the suspicion that the baby is becoming too large. Contrary to popular opinion, suspecting a large baby does not automatically make grounds for induction. It is actually very difficult for anyone, qualified or otherwise, to accurately determine the size of a baby prior to birth, even with the use of ultrasound. "Studies consistently show that inducing for a suspected large baby increases, rather than decreases, the incidence of having a caesarean birth." 127 "Multiparity (pregnancy after one or more previous pregnancies) is the most common reason for being large for dates. The uterine muscle and the abdominal muscles are a bit more relaxed so mothers show earlier and the uterus tends to start out a bit larger. Women who have had previous cesarean births may also start out a bit larger." 128 "It is often said that "the only good pelvimetry is a baby's head" - i.e. there is no point trying to measure the dimensions of a woman's pelvis, because the only way of knowing whether the baby can pass through it, is for her to labour." There is more information at iVillage: Big baby: Is induction of labor necessary?
• Know the classifications used by healthcare professionals when discussing the need for a caesarean. Knowing this classification can help you be more involved in the discussion if you find yourself in an emergency situation
• Continuous labour support - The majority of women will be cared for by midwives during their birth (midwives are also present during a caesarean) and it is widely accepted that the presence of a midwife can reduce the likelihood of a caesarean where medical indications are borderline. 17 23 This is because they are present expressly to provide you with support and guidance for a vaginal delivery. They are very experienced in childbirth and can monitor your situation throughout your labour. They also know your wishes and can help discuss the progress of your labour if other health professionals are managing your delivery. Unfortunately due to staffing levels it can be difficult for hospitals to ensure that you will have one to one care on your delivery day(s). Staffing levels vary significantly across the country 14. The National Sentinel Caesarean Audit working party recommends that, in order to achieve one-to-one support of women in labour, the ratio of midwives to women in labour on a labour ward should be 1 to 1.15 49. If you are concerned that you have not been designated one to one care during your labour you might consider arranging for a private midwife or doula. There is some evidence to suggest that having a Doula present at the birth can halve the likelihood of having a caesarean. A Doula is there to support you both emotionally and physically. Doula.or.uk conducted a survey in 2004 to assess the impact of their services 116. They discovered that:
  • 79% of women had hospital births
  • 21% of women opted for and achieved a home birth (compared to a 2% national average - National average based on NHS maternity statistics)
  For those who had their babies in hospital:
  • 10% of these births ended in caesarean sections (compared to the 22% national average)
  • 15% had an epidural (compared to the 33% national average)
  • 7% had instrumental deliveries (compared to the 11% national average)
  • 8% opted for and achieved VBACs (vaginal birth after caesarean)
  • 43% were primiparas (first baby)
  • 22% were labours or births in birthing pools (whilst national data is not available this statistic is believed to be much higher than the national average)
• Birth setting - This can directly influence the amount of medical intervention you are likely to receive and starting as a home delivery can help to reduce the likelihood of a caesarean. This approach will reduce your pain relief options but it does not preclude you from transferring to hospital should you then need to