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

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.

Check out the AP’s article here.

The burden of so many cesareans is starting to weigh on more than just the women and families involved.  Regulators are beginning to hold practitioners and hospitals accountable:

Hospitals also will have to report cesareans for first-time mothers, too often a result of a failed induction.

“That’s not a good outcome for the baby or the mom,” says joint commission president Dr. Mark Chassin. “We believe this will be a very important driver of improvement in perinatal care.”

It’s time that those who set the rules and protocols for hospital birth start to realize that unnecessary cesareans are not a good outcome -  as more babies have respiratory problems, moms have much longer and more difficult recoveries while simultaneously caring for a newborn and possibly other small children, and many moms suffer from post-op infections, not to mention many other risks and side-affects of major abdominal surgery.

For more info on inductions check out Henci Goer’s articles on elective induction and due dates. Henci Goer has made combing the medical research for best practices and translating that evidence for the rest of us her life’s work.  She is the author of The Thinking Woman’s Guide to a Better Birth.

Nursing Birth gives some great advice in her “Don’t Let This Happen to You” series when describing how one couple dealt with an induction.   Nursing Birth accurately describes the birthing climate in many of today’s hospitals and writes from an evidence-based point of view.

Related Posts:

• Do We Even get a Choice?
• One Choice We Make: Where Do We Give Birth?
• Good Things Come to Those Who Wait

Pregnant the second time, Jennifer was determined not to repeat her first experience.  Her first order of business was to find a supportive caregiver.  She had two litmus tests for each doctor she interviewed: “Do you support VBAC?” and  “Do you encourage repeat cesarean  for women who haven’t gone into labor by 41 weeks?”  Both of these were deal-breakers for Jennifer.    Coming from a family who has a history of babies being born between 41 and 43 weeks, she was not going to settle for a practice who routinely induced at 41 weeks.  It was imperative that she be given the opportunity to let labor begin on its own.  Committed to putting herself on a different path for this second birth, if she didn’t like the answers to either of those two questions,  she scheduled another interview with yet another doctor.

After several interviews with several practices she finally found an OB who was more than nominally supportive of VBAC and who looked at the big picture before encouraging induction.  Then as she educated herself about the various interventions, she decided that this time around she wanted to avoid an epidural for as long as possible as she was convinced that this had significantly slowed things down last time.

As her due date came and went,  she was sent in every 3-4 days for a biophysical profile.   She made sure to stay very hydrated so that she had the best chance at her amniotic fluid not appearing too low.  She also made sure to eat something before the visits so that her baby would be awake and energetic during the tests.  She stayed calm and did not stress out as 41 weeks passed.  41 weeks 2 days.  . . 41 weeks 4 days. . .

Her due date was just around the corner and still there were few signs that labor would be commencing any time soon.  Stripping the membranes wasn’t an option as she wasn’t dilated enough for the doctor to perform the procedure.   Her OB finally gave her a deadline of 42 weeks 3 days.  If her body hadn’t done something by then, medical interventions were going to be pursued.  The clock was ticking, but Jennifer stayed calm.

Of course Jennifer did not wind up becoming the first eternally pregnant woman.  At about 11pm on the eve of 42 weeks past her due date labor began.   Throughout this labor she and her husband  made many decisions to help make sure she stayed on a path that had the best chance of ending in a vaginal birth.

The first nurse assigned to care for her did not want her out of her bed when hooked up to the fetal monitor.  Jennifer immediately knew this was not a good fit.  She requested a new nurse from the charge nurse and was presently assigned a nurse who was studying midwifery.  Much better!

Later when her blood pressure was showing high readings, she labored on her left side even though this made dealing with the contractions much more difficult.    Jennifer knew that if her blood pressure didn’t come down, she wouldn’t even have the option of dealing with contractions as she would soon be having another surgical birth.   Laboring on her side was super effective at keeping her blood pressure in the normal range.

When the doctor on call (not the same doc who had cared for her during the pregnancy) lectured her on the risks of VBAC while she was in active labor, and later the risks of shoulder dystocia as this baby looked large, Jennifer kept her cool.  She had educated herself on these things before the birth and was more comfortable with VBAC  and birthing a large baby than she was with the risks associated with major abdominal surgery.

Lastly, she changed positions every 4 or 5 contractions while pushing to effectively use gravity and lots of movement to bring her baby down.   It so amazing when  Jennifer finally eased the baby out. Not quite two hours since she had begun, Jennifer pushed out all on her own body’s power, a 9lb 5 oz.  baby boy.  It was so amazing to see.  He slipped right out and was placed right on her chest to hold and cuddle and nurse.

VBAC moms always impress me.  Not only becasue they face the normal challenges of labor and birth (which are significant!) but they have the added challenge of birthing in a system and an environment that is not designed to facilitate VBAC.  It took determination, patience, and  skilled high pressure negotiation (there’s not much more pressure than when your doctor tells you that your baby might die from the decision you are making!) just to get to the moment where she could even have the opportunity to go into labor.     She later told me that the next day a nurse came in and told her that she was the only one of the floor to birth vaginally that night.

Jennifer had learned since her first birth that it was not her body that had failed in her first birth, but the induction. Her body simply wasn’t ready to give birth yet when she went in for the induction and so the labor was more difficult and ended in a surgical delivery.  This time around, Jennifer’s determination to trust in her body and give it the time it needed payed off.

Good things come to those who wait.

I know that culturally to Americans, this makes no sense at first glance.  We are programmed culturally to respond that when we throw more money and gadgets at a given situation, we feel  like it has to be “better.”  But in the case of childbirth, less is actually more.  The less we interfere with high tech measures and the more low-tech emotional and physical support we give women,  we have more healthy moms and babies.

Check it out here:   Midwives: A Safe, Cost-Saving Alternative

And here: The Milbank Foundation Outlines how midwifery care has better outcomes and lower costs.

Reducing Infant Mortality from Debby Takikawa on Vimeo.

Screnshot from the trailer of Reducing Infant Mortality

Just saw on UnneCesarean a post about a free online film being released on July 26th: Reducing Infant Mortality and Improving the Health of Babies.  It highlights the sad fact that too many babies are dying in the U.S. around the time of birth.   As health care is debated on Capitol Hill this summer,  this film is hoping to bring light to a particularly dark corner of our health care system.

I knew that in the US,  we ranked very poorly overall, especially when compared to other developed nations (42nd in fact).  I learned watching the trailer that it is even more perilous for African American babies in the U.S. With a rate of 16 deaths per 100 births, African American babies are close to 2.5 times more likely to die around the time of birth than babies from the general population in the U.S.  This is scandalous.

Experts interviewed for the film are Obstetricians, Family Physicians, Midwives, MD’s, Doulas, and PhD’s including:  Michel Odent, Thomas Verny, Marshall Klaus, Phyllis Klaus, Marsdsen Wagner, David Chamberlain, Karen Strange, Robbie Davis-Floyd, Jennie Joseph, Sarah Buckley, Bruce Smith, Yeshi Neumann, Paul Fleiss, Maria Iorillo, Stuart Fischbein, Debra Bonaro-Pascali and Judith Prager.

Watch the trailer here:    Reducing Infant Mortality

Get Involved Here:  Reducing Infant Mortality: Take Action

The Lie of the EDD: Why Your Due Date Isn’t when You Think
How the 40 week pregnancy myth came about and why it’s totally wrong.

Just another reason to sit back and not fiddle with mother nature. It’s crazy to think that if  mama has a funky cycle she’s more likely be induced for being post-date which could result in a premature baby because the way  due dates are calculated doesn’t account for variations in women’s cycles.

When mama and baby are OK, there is no good reason to hurry things along.  Waiting for Baby to come on his/her own time (even if that time is closer to 42 weeks) gives everyone the best chance.

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.