Avoiding an Unnecessary Cesarean

A cesarean delivery may be necessary to save the life of the woman or baby. But an unnecessary cesarean should be avoided at all costs, as there are risks involved. Cesarean section is major abdominal surgery, and, as does any surgery, it carries with it the risk of infection, hemorrhage, pneumonia, blood clots, and anesthesia-related complications, along with increased financial costs, additional discomfort, and longer recovery. A cesarean baby is at a higher risk than a baby delivered vaginally. He is more likely to suffer from premature birth, asphyxia, or a breathing disorder. The resulting problems, intensive care, and financial costs can be overwhelming.

The chances of having a cesarean delivery can be affected by certain hospital practices during labor and even by the choice of caregiver. Selecting a midwife or doctor who favors family-centered childbirth and has a low cesarean rate will decrease the chances of having a cesarean. Women who have a certified nurse-midwife as their caregiver have the lowest rate of cesarean deliveries. This is because these practitioners treat mainly low-risk women and are less likely to use interventions or epidurals during labor. Women are more likely to walk during labor, and they benefit from the one-on-one personalized care given by the nurse-midwife.

Having continuous support from a labor partner can also lessen the chances of a cesarean. The use of a doula can reduce the chances even further. A doula’s presence provides a supportive atmosphere and is often accompanied by a dramatic reduction in interventions.

The use of Pitocin or artificial rupture of the membranes to induce labor can change the type or the force of the labor contractions, can precipitate fetal distress, and can create potential hazards for the woman and baby. Failure of induction is a common reason for emergency cesarean section. Labor should be induced only if a medical reason exists. Since the 1980s, there has been a steady increase in the number of births occurring during the week and a corresponding decline in the births on weekends. This concentration of births during the week is caused by an increase in the number of inductions of labor. Cesarean sections as a result of failed inductions have also increased.

In a normal labor, early intervention (such as amniotomy, Pitocin, pain medication, or epidural anesthesia) may lead to complications that indicate a cesarean delivery. The rule that every baby should be delivered within 24 hours after rupture of the membranes or within a specific amount of time after the onset of labor increases the chance of a cesarean section. Some doctors closely monitor a laboring woman for signs of infection by keeping track of her temperature and blood count instead of routinely performing a cesarean after 24 hours with ruptured membranes.

Hints for the Mother-to-Be To avoid a cesarean:
  • Select a caregiver with a low cesarean rate.
  • Hire a doula.
  • Have a supportive labor partner.
  • Avoid Pitocin and elective induction.
  • Walk during labor.
  • Avoid an epidural and medication.
  • Request that monitoring be done intermittently.

A woman’s position during labor can affect her need for a cesarean delivery. Walking can assist the normal progression of labor. Walking has been shown to improve the quality of contractions, to shorten labor, and to improve the condition of the baby during labor and delivery. Lying flat on the back can cause supine hypotension and fetal distress.

An electronic fetal monitor may be indicated and beneficial for a higher-risk woman, but when it is used routinely for a low-risk woman, it can increase her chance of having a cesarean delivery. For example, insufficiently trained personnel may misinterpret its readings. They may overreact to abnormalities in the fetal heart tracings, which may just appear to indicate fetal distress. If dilation is sufficient, an internal monitor should be applied to verify any readings of problems by an external monitor.

Abnormalities in the fetal heart rate tracings can also be confirmed by a fetal blood test. A blood sample can be taken from the baby’s scalp to measure the pH. Not all hospitals are equipped to do this, however, and not all doctors take advantage of it, perhaps because of a lack of knowledge or skill in this area. The equipment needed for this test is very sensitive and must be maintained and operated by a skilled technician to ensure accurate results. Utilization of this test may help to avoid many unnecessary cesarean births.

The electronic fetal monitor also limits mobility during labor. Some nurses insist that a monitored woman lie on her back to ensure a good tracing. Lying flat on the back can lead to supine hypotension and fetal distress.

Epidural anesthesia can inhibit the force of contractions and prolong the second stage of labor, affecting the urge to push and the effectiveness of the pushing. An epidural can complicate a potentially normal labor and delivery, decreasing the baby’s oxygen supply because of low maternal blood pressure and therefore increasing the likelihood of a cesarean delivery. An epidural may also relax the pelvic muscles and thus affect the rotation and descent of the baby.

Analgesics and sedatives can slow labor, inhibit the force of contractions, or depress the baby’s heart rate, thereby indicating the need for a cesarean section.

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