April is Cesarean Awareness Month, so I thought today would be a great day to discuss C-sections and VBACs (Vaginal Birth After Cesarean). As a Cesarean and VBAC mama, I will be the first person to tell you that sometimes C-sections are necessary. It is so awesome that modern medicine can save the lives of two people, mom and baby, with one surgery. This can definitely be the case in certain instances such as placenta previa. Unfortunately Cesarean deliveries are overdone here in the United States. Reasons for the C-section rate growing include things like doctor convenience and not just because of medical necessity.
What is an adequate Cesarean rate?
Back in 1985, the World Health Organization declared that 10-15% was a reasonable rate. In April of 2015, they released a study by the Human Reproduction Programme that stated that rates over 10% do not improve mortality rates. That study can be found here. In May of 2017, Consumer Reports did their own study on Cesarean rates around the United States. Their study found that the Department of Health and Human Services has declared that “almost all hospitals should be able to achieve a rate under 24 percent, and hospitals should be able to aim even lower.” Unfortunately one in 3 births is ending in a Cesarean with some hospitals having as high as a 61 percent C-section rate. Consumer Reports went on to find that the rates were definitely effected by where you give birth.
How can we reduce this rate?
- Be choosy on your care provider. You should spend as much time researching your obstetrician or midwife and birth location as you do which car seat to buy. I recommend interviewing at least three care providers to find out how they practice. See my list on choosing your provider here.
- Avoid an initial Cesarean. Even though the American College of Obstetricians and Gynecologists recommends VBACs for most women including those who have had two, found here, many hospitals and doctors still promote the once a C-section always a C-section mindset.
- Hire a doula. Doulas have been found to reduce the chance of Cesarean by as much as 60% in some studies.
- Stay mobile as long as possible. Movement and being upright during labor helps the baby move lower into your pelvis. Laying flat on your back narrows the pelvic inlet making it harder for baby to descend.
- Avoid unnecessary interventions. Inductions make movement limited due to being restricted to a bed. Pitocin makes the strength of contractions harder making it more difficult to avoid pain relief. Pain medications also affect your mobility. These medications are also not without risk. They can cause baby’s heart rate to drop requiring a C-section.
- Attend good childbirth classes. Don’t attend most hospital based classes. These classes are mostly intended to teach hospital procedures and when to expect your epidural. I talk about my experience with the Bradley Natural Childbirth classes here. I have also seen clients have good experiences with Hypnobirthing.
- Don’t be afraid to say no or ask for more time. You hired the doctor/midwife to do a job for you. They are not an authority figure. Ask questions. Have them list pros and cons. Unless it is an obvious life threatening emergency, ask for time to discuss the decision privately.
- Have a birth plan. Not so much to present to your care provider what you will or will not allow, but as a way to help you research all procedures that you may be presented with. Bradley classes teach you to prioritize which ones have the most importance to you.
I have had a C-section and am pregnant again, now what?
- Join support groups. The International Cesarean Awareness Network is a great resource. Facebook is great for local groups. In the North Texas area, we have the North Texas VBAC Connections and DFW VBAC/Cesarean Support groups.
- Find a supportive care provider and birthing place. Discuss with your obstetrician or midwife about whether you are a candidate for a VBAC or whether a repeat C-section is necessary.
- Research the risks and benefits of VBAC vs repeat Cesarean births. Great info is listed here.
- If choosing a VBAC, make sure that whoever you choose is VBAC friendly not just VBAC tolerant. VBAC Facts can help you find which hospitals are more supportive than others. Many hospitals, especially hospitals in smaller towns do not offer VBACs at all. Don’t forget to find out your individual care provider’s VBAC policies and rates. Atlanta Birth Doula has a great graphic that shows the difference between a VBAC tolerant and VBAC supportive provider.
What are some ways to ensure my VBAC success?
1. Wait at least a year to get pregnant. Studies show that uterine rupture rates decrease after a year and even more two years after a Cesarean.
2. Eat a diet high in protein and low in sugar and carbs. You want to get at least 80 grams of protein per day. And don’t forget to drink lots of water. The Brewer Diet is a great one for pregnancy.
3. Do Mayan abdominal massage to help break up adhesions. Most physical therapists that offer this prefer to start before you get pregnant. If you are already pregnant, they wait until the second trimester to start. There are instructions on the Internet and classes that you can take. I really liked the directions that I found four years ago for my VBAC pregnancy, but have been unable to locate them since.
4. See a chiropractor. Chiropractic care gets your pelvis aligned and release tension in the uterine and pelvic floor muscles. These things can help ensure optimal fetal positioning. Pathways to Family Wellness has a lot of great articles on chiropractic care and pregnancy.
5. I am going to say it again. Hire a VBAC friendly care provider and a doula. Many women seeking a VBAC have emotional issues or fears to work through. Doulas are a great resource for working through that before and during labor.
Did you have a Cesarean? How do you feel about it? Are you considering a VBAC? Contact us to set up a free consultation to see if a VBAC is right for you. Don’t forget to subscribe at the top to get the newest blog posts sent directly to your inbox.