According to the American College of Obstetrics and Gynocologist in 2011 1 in 3 women who gave birth in the United States, did so by Cesarean Delivery. While a Cesarean delivery can be a life saving procedure, the increase in cesareans has not caused a decrease in maternal and infant mortality or morbidity. Unfortunately such an acknowledgement raises a concern that cesareans are over used.
Some of the leading causes that you may have been told are a reason for a cesarean are:
- Labor Dystocia – Labor that doesn’t progress as quickly as expected
- Abnormal or non assuring heart rate
- Breech Position
- Large Baby
What does this mean for women?
Prolonged labor or labor lasting longer than 20 hours is no longer an indication that a cesarean is necessary. Cervical dilation less than 6cm is considered to be early labor.
Longer pushing times are normal especially in the case of a breeched position or in the use of an epidural.
Induction should not happen before 41 weeks gestation unless medically necessary. So holidays or your providers schedule are not good reasons to induce labor.
Twins outcomes are not increased by cesarean delivery.
Providers should support vaginal birth as an option
Large baby/small mother is not a reason for a cesarean birth. Macrosomia (large baby) as determined by ultrasound is not a reason for delivery, and rarely an indication for cesarean delivery.
Late pregnancy ultrasound increases the cesarean rate with no evidence of benefit to the baby.
To avoid potential birth trauma, recommendation of cesarean delivery is limited to estimated fetal weights at least 5000g (11 lb) for women without diabetes or 4500g (9 lb 14.7 oz) for women with diabetes. These minimum weight estimations for cesarean delivery take into account concerns regarding shoulder dystocia.
Estimates of fetal weight in late pregnancy are imprecise and instances of babies reaching 5000g are rare.
“Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane metaanalysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery (111). Given that there are no associated measurable harms, this resource is probably underutilized.”
You have choices, many women have approached Birth without being aware of their options. There are many medical facilities that still use outdated practices. It’s so important to know the information available and advocate for your health. With maternal mortality, morbidity (near death), and pre mature births on the rise knowledge is a protection.