32.3%

of all babies born in the U.S. last year were born by Cesarean section.

• 12th consecutive year that the Cesarean rate has increased
• the total number of births decreased 2% from 2007 to 2008

See that dip when the rates went down a bit?  That was in the 1990’s when the trend was to encourage moms to have a VBAC.  Then policy changed and we are now at the height of an epidemic that doesn’t seem to be slowing down – especially if an entire state can have an average cesarean rate of 40%.

So in light of the craziness that is going on in U.S. hospitals, you can do a few things to increase your chances that your birth isn’t just a 1 in 3 crap shoot of whether or not you end up with major surgery:

10 Ways to Avoid an Unnecessary Cesarean

Avoid Unnecessary Induction

Carefully Choose Your Provider

Have Great Support at Your Birth

Avoid an Unnecesarean

I describe pushing the baby out kind of like trying to take off my wedding band – with the pelvis being like the ring (I know it’s not perfect, but you’ll see what I mean in a sec.)  I’ll  grab hold of my wedding band and pull forcefully toward the tip of my finger.  In variably, it moves a fraction and then gets stuck.  The flesh between the band and my knuckle gets all bunched up, my finger starts to turn frighteningly red, and I begin to wonder if the ring will ever come off. On my second try, I tug on the ring while gently jiggling it back and forth.  This time it moves right along without any trauma to my finger at all.

All of the moving and changing positions while pushing  – hands and knees, lunge (or Captain Morgan position),  side lying,  squatting,  sitting on a toilet, standing – are the equivalent to the jiggling I did to ease my ring off.  Lying flat on your back and pushing with all your might for two hours or more is the same as grabbing my ring and yanking full force.  In theory yanking can get my ring off, but there sure are gentler more effective ways of doing so.

If you are interested in a gentler more effective way of pushing your baby out check out this fantastic video from mothersadvocate.org:

While we are talking about pushing, I have to mention the fact that you may be asked to not push when you feel VERY much like doing so.  In fact, if you are having the overwhelming urge to push it is going to be a lot like throwing up, except this time your body is throwing down.  You can’t help it.  Your body is on a mission of expulsion and you are along for the ride.

So let’s say you find yourself in a situation where your body is very much telling you that PUSHing is what needs to happen and the people  around you are telling you not to.  The first thing you do is find out WHY.  If there is a good reason why you shouldn’t be pushing -  like you went though transition at how and now you are in the car and you really don’t want your baby to be born on Lake Shore Drive.  Or if  your baby’s cord is prolapsed and the pushing is jeopardizing the baby’s oxygen – those might be situations in which you might not want to push.

If that’s your situation there are a couple of things you can do: Blow Raspberries.  This is where you blow forcefully and let your lips flap away.  Like if you were going to imitate a horse noise.  I used to call this “horse lips” until a client misunderstood me and thought I said they were getting out the forceps. For me they are now forever “Blowing Raspberries” as I don’t like to terrify women in labor.  Blowing out like this keeps you from holding your breath and bearing down.

I have had personal experience with this one with my second child.  She came unexpectedly fast and I didn’t have the luxury of birthing in a facility with L&D rooms.  I was in an L room when the throwing down began and I the nurse desperately needed to get me to a D room two floors below!  My dear second daughter could have been born in an elevator, but I wasn’t too excited about that so I did my best to not encourage my body and two pushes was all it took once we got to the D room.  (I certainly hope they put some more thought into the design of that place down the road!)

Then there was the time when I was a doula for a primip (mama giving birth for the first time) who was having an exceptionally quick labor. I didn’t even made it to their home to support them it went so fast.  As I was turning down their street the dad called me to say they were headed to the hospital.   I saw their car pass me, made a U-turn and pulled up right behind them.  I stayed on the phone with the mom while following them to the hospital.  She was vocalizing loudly in the back seat and it sounded like transition.   I coached her as best I could through a hands-free device.  All things considered she was doing marvelously.  Soon I heard a catch in her voice and knew that she was feeling like pushing.  So for the next 10 minutes getting to the hospital we blew raspberries to each other on the phone.   She did a fantastic job and was able to push her beautiful baby out in two pushes once she got to L&D.

So there are times when it might be a good idea to not push even though you feel like everything in your body is focusing on bearing down.  However, I have witnessed on several occasions in several different hospitals circumstances where a mother is experiencing an overwhelming urge to push and everyone around her is telling her not to, and the only reason is because her chosen care provider is not in the building yet.

One time it was another surprisingly quick primip.  Other occasions it was winter in Chicagoland and the labor progressed quicker than the snowplows could keep up with the snow, so the doc was in transit.  Every single time a L&D nurse was present and every single time there was also a qualified OB on the floor who could have stepped in at any moment.  All of these mothers were unmedicated.  The main reason the mother was told not to push was because the staff wanted to wait until the mother’s chosen care provider arrived on the scene.  Arrgh!

If this is your situation and you don’t care who catches your baby (an L&D nurse can catch a baby just fine) then go ahead and push!  Not pushing with an overwhelming pushing contraction is pure misery.  If  not pushing along with you body saves your baby’s life, I am all for it.  However when it is simply for the convenience of someone other than the birthing mother, I am all for tuning in to your body, informing the staff that the baby is coming – doesn’t matter who is or isn’t in the room – and birthing your baby.

Another great resource for pushing and following what you body is telling you can be found here.

You may also like:
Good Things Come to Those Who Wait – Successful VBAC mom who did tons of scooching and changing positions in second stage

The more I am around birth the more I have opportunity to see that these interventions we have can be both blessings and curses to laboring mothers.  The more I am around birth the more I see births that truly did need medical intervention.    And on the flip side the more I am around birth, the more I see births that certainly could have done without so much fiddling.

And so I get to Christine’s post on Pitocin.  I think it’s great because it cautions parents not to  blindly enter into an elective induction or augmentation simply for the sake of time when mama and baby are both doing fine.  I have supported labors where the labor was progressing just fine and the OB ordered Pit simply because that’s how she rolls, and then watched as the baby quickly became distressed.  I have also supported labors where a little Pit at the end of a long labor kept the mom out of the OR by giving her body the nudge it needed to finish well.

So to all you pregnant women check out the link, learn a little about Pit, watch the video clip and then file that info away for your labor or your discussions about inducing your labor. . .

And to you mama’s who have labored before with Pitocin -  I’d love to know what your experiences with Pit have been.  Love it?  Hate it? Necessary? Unnecesary?

My personal Pit experience was with number two.  I was unnecessarily induced.  I was in early labor and didn’t realize it and was asked to come in for an induction.  At that point in my life I didn’t even think to question the advice so we went home (THAT should have been a clue that the induction was NOT a medical emergency!!) got our stuff and returned for the induction.  Well, I certainly didn’t need it.  Within two hours of starting the Pit, I was in the throes or transition and my dear little daughter was almost born in the elevator on the way to the delivery room.  (She was born overseas in a maternity clinic that had a LABOR floor and a DELIVERY floor.  You have no idea how sensible the whole L&D combo is until you are trying not to birth your baby in the hospital’s elevator!)  I would have much preferred my body’s slower pace because it would have been so much more manageable.   Spreading out all that work over a little more time would have been so much nicer.

So there’s my little trip on Pit.  What’s yours??

Some of these situations we cover are  not necessarily dangerous for the mom or baby, they just change the options that are given to the couple.  Being post-date or going past the due date is one of these.  Depending on your caregiver’s policy induction may highly encouraged anywhere from 39 weeks 6 days to 41 weeks 6 days.  That is a BIG difference.  And if both mom and baby are fine, then they have a lot of options including refusing an unnecessary induction at 40 weeks on the dot.

Another option-changer is breech position of the baby.  While there is a movement in Canada to encourage vaginal delivery of breech babies, the recommended route here in the US right now is surgical.  And since many OB’s do not have the proper training or experience with vaginal breech deliver, I am not comfortable advising moms to ask for vaginal breech delivery with inexperienced caregivers.  So, for parents who find out before the onset of labor, there are many things they can do to encourage the baby to turn: lots of positions for mom to try, chiropractic adjustments, acupuncture, etc can be effective at turning many babies.

So when preparing for these discussions tonight, I came across Dr. Onyeije’s presentation on avoiding a Cesarean.  It mirrors so many of the things I try to stress in class, the  most important being finding a caregiver who shares your perspective on birthing.

That one thing can pave the way to avoiding so many difficult situations for a pregnant couple.  If you are wanting a natural childbirth and go to a practice with a high rate of intervention, then you will probably be very discouraged.  If you want every bit of technology used on you and your baby from the first twinge and you are with a more laid back practice, you will be so frustrated when they send you home from the hospital when you are at 3cm and still in early labor. It makes SUCH a difference.  I they to encourage couples that statistically they will not be the exception.  Exceptions are out there, but you can’t expect to be the exception for the particular practice you are using.

So here it is: 

Here is an excerpt from her article and you can plainly see how where you go to give birth can play a huge role in your outcome.

Advocate Good Shepherd Hospital in Barrington—35 percent (1,724 births 601 C-sections)

Advocate Medical Center in Oak Lawn—35 percent (4,233 births 1520 C-sections)

Resurrection Saint Joseph Hospital, Chicago—34 percent (1895 births 647 C-sections)

Advocate Condell Medical Center Libertyville, 30 percent (545 births 165 C-sections)

University of Chicago Medical Center, 29 percent (2,013 births 585 C-sections)

Advocate Illinois Masonic Medical Center, Chicago, 29 percent (2,931 births 866 C-sections)

Northwestern Memorial Hospital, Chicago, 28 percent (11,958 births 3,418 C-sections)

Elmhurst Hospital, 26 percent (1,426 births 374 C-sections)

Evanston Hospital, 26 percent (3,590 births 966 C-sections)

Adventist Hinsdale Hospital, 26 percent (2,252 births 588 C-sections)

Swedish Covenant Hospital, Chicago, 25 percent, (2,464 births 618 C-sections)

West Suburban Hospital, Oak Park, 20 percent (2,175 births 453 C-sections)

University of Illinois Medical Center, Chicago, 14 percent (2,893 births 433 C-sections)

Some notes about the three hospitals with the lowest cesareans:

• UIC is one of the few hospitals in the area that supports vaginal birth after 2 cesareans (VBA2C).  Most hospitals in the area view women who have had multiple cesareans as too risky for vaginal births and schedule them for repeat cesareans.
• West Suburban and Swedish Covenant both have alternative birthing centers on the premises used by midwifery practices that support natural childbirth and evidence based maternity care.  Women birthing in these birth centers aren’t forced to having labors conform to a curve or else face called cesareans for: “Failure to Progress”, “Arrested Labor,” or “Cephalopelvic Disproportion- CPD.”

if your hospital is not listed here, leave a comment and I’ll crunch the numbers and post your hospital’s rate.  Or you can check out the report yourself and leave it in the comments.

2008 Illinois Hospital Profiles

It does make a difference where you choose to give birth.

First of all, it is the most perfect food for your baby.  Breastmilk changes to meet your baby’s needs.  If it is really hot, your breastmilk will have a higher water content to make sure your baby stays properly hydrated.  If your baby has been exposed to a cold virus, your body will help make antibodies specific to that virus and send them along to your baby.  The colostrum available immediately after birth is high in vitamin K, acts as a laxative to helps get your baby’s new digestive system moving along, and is full of antibodies that are not present on the colostrum of a pregnant woman.

Some for the benefits to the whole family are:

• It saves money – the cost of a year’s worth of formula is about the same as replacing a major home appliance
• They smell better – The poo of a breastfed baby does have a smell, but it’s a kind of musty, earthy, light smell.  Formula poos reek and can fill an entire house, much less a room.
• Easier travel – It’s always there in the right amount, at the right temperature.  It’s nature’s convenience food – ready when you want it – no mixing, preparing or sanitizing required.
• Better sleep – Nursing while lying down and dozing can make getting through the night so much easier.

Some benefits for baby are:

• Less diaper rash – Poo from a breastfed baby is less irritating to its bottom than formula poo
• Less likely to become obese as an adult
• It’s great for their teeth – so maybe saving on orthodontic bills is a benefit to Mom and Dad, but your child just might be thankful they got to skip out on years of braces, too. All that extra work a baby has to do to breastfeed is great for their developing facial structure.

While moms can benefit from all of the above, here are a couple just for us mamas:

• Studies have shown that breastfeeding for a total of at least 24 months (the sum of all the months of breastfeeding with all her children) can significantly reduce a woman’s chances of developing breast cancer.

• Breastfeeding can help a woman lose extra weight gained in pregnancy – It’s part of the natural process of returning to a non-pregnant state.  In pregnancy most women require an extra 300 calories a day – while exclusively breastfeeding that can increase to 500-700 more a day.
• Breastfeeding right after birth can prevent postpartum hemorrhage. Immediate breastfeeding stimulates oxytocin production in the mother which encourages her uterus to clamp down on the open vessels of the site from where the placenta has just recently detached.  This ensures that the mother’s blood loss after the birth is minimal and speeds up her recovery time.

Moms who have excellent nutrition (read naturally colorful food that remembers where it came from – no super processed, corn-syrup laden, trans fat drenched beige food that resembles nothing of its source) and who are otherwise healthy and low risk can birth full term normal birth-weight babies naturally.

I know it’s anecdotal, but this very thing happened to my grandmother. Back in the 40´s she was pregnant for the second time. She told me that she got really big, but apparently didn’t have time to think much of it since my grandpa was recently back from the war and she was so busy caring for my 18 month old uncle. Birthing at home was still the norm in her part of Southern Ohio, so she had a second homebirth. After my aunt was born, my mother’s presence wasn’t discovered until the doctor was packing up his bag and the nurse said to all present, “Uh, I think there’s another one in there!” And soon thereafter,my mother was born. Both of them weighed over 7 lbs at birth.

If you are pregnant with twins and would like to have a natural childbirth, it is possible. One of the biggest hurdles to that possibility will be your careprovider. So if you find yourself pregnant with multiples and would like to be given the option of a vaginal childbirth, you may have to extend your search beyond the same OB/Gyn who has done your Pap smears for the past 10 years. Finding a supportive provider has got to be the first step.

After that read books (Like Your Best Birth – I’m really enjoying it – review soon to follow), eat exceedingly well, get regular physical exercise, take a natural childbirth class, choose your birthplace, go to spinningbabies.com to learn exercises and postures that encourage babies to get and remain head-down.

We each  must deal with specific circumstances of the birth we are given, but we can learn ahead of time about the choices we will have along the way.  And for those with multiples, natural childbirth can be an opition.

I spoke with a woman last weekend who would love to have a home birth but her insurance won’t cover one.  And the homebirth practice she was considering would cost her close to $7,000.  So then I asked her about going with a group of midwives who have an alternative birthing center.  She informed me that the only maternity reimbursements that her insurance provides are for MD’s.  She is healthy and low-risk and cannot even consider maternity care from a midwife.

I have heard of women whose coverage wouldn’t apply to the birth  if they were “allowed” to go past 41 weeks.  So in order to make sure that the birth was covered by their insurance they must undergo a costly, invasive, medical induction that increases their chances of a cesarean simply becasue their insurance policy arbitrarily states that it must be so.

So now we turn toward Texas where a judge recently ruled that Medicaid is not required to reimburse birthing centers for their facility fee when a woman using Medicaid gives birth there.  Medicaid will continue to reimburse hospitals (at a much higher cost) when women birth there, but the more cost effective option of the birthing center is being denied any reimbursement.  Also this ruling is not limited to Texas; it would apply nationally. Once again a medical plan is not even giving women  a choice when there exist several good options.  I’m not advocating that all low-risk women must give birth in a birthing center, only that if they have that option in their area they should be able to consider it.

If you would like to communicate your opinion about this ruling you can go here to do so: Consumer Letter to Congress

Childbirth Connection has great information on evidence-based maternity care and an excellent discussion of how current reimbursement practices actually encourage more intervention and less tolerance of supporting normal physiologic birth.  Pages 59-67 of their report Evidence-Based Maternity Care: What It Is and What it Can Achieve adress these concerns specifically.

As a childbirth educator and a doula I see my role as helping women to see the full range of options they have in various cincumstances so that they can make an informed decision about their care.  Unfortunately, the reality is that unless these women happen to be of certain means, their options are in reality much more limited than they appear at first glance.