Blog Banner

Monday, March 23, 2015

C-Section Prevention for the High Risk Pregnant Woman

So you have been told by your medical caregiver that you are high risk. What does that mean for you? If you are not careful, and do not plan ahead, it means that you are far likelier to have a C-section. While in some cases, this may be medically justified and even necessary, there are a lot of times when this surgery is used as a first resort instead of as a last resort. In other words, they will schedule a C-section before your due date, without letting you know that you may have other options.

So, what are the elements of high risk? Some of these include gestational diabetes, preeclampsia or eclampsia (high blood pressure), breech at a few weeks before the due date, and macrosoma (or a baby that appears too large on an ultrasound). There are other high risk conditions as well, but these are the most common.
Photo By David Castillo Dominici

So the first two conditions, gestational diabetes and high blood pressure, have the potential of being reversed before your due date. To make this more likely, you can consult with a nutritionist. Most doctors do not have the knowledge of nutrition that would be required to help you reverse these conditions. They provide a dietary plan that may not be sufficient or complete to help fully with these conditions. There are also supplements that a nutritionist or herbalist may recommend, such as glutamine or protein powders, to help increase your protein intake while keeping your blood sugar stable. Other supplements, such as green tea or chia seeds, may be safe during pregnancy, and have been shown to reduce blood pressure.

For breech babies, many doctors and most midwives know that there are techniques that can be used to help turn the baby. These techniques should be used in the weeks before labor, and some can be found on the Spinning Babies website, located here. While they may not work all of the time, they do work a significant percentage of the time.

Macrosoma is a term that has come into fashion in the last few decades. It is the idea that a baby could possibly grow too large to be born naturally. This is simply a fallacy. Our bodies are very intelligent, and in general would not create a baby too large. You can find stories of many midwives who have delivered supposedly macrosomic babies (10 pounds or larger) without an issue. You can also find just as many stories of erroneous reading of the ultrasound data, or an incorrect macrosomic diagnosis, usually after the c-section has already been carried out.

In addition to the above suggestions, you can also increase your chances of a natural birth in a couple of other ways. Some of the most effective are listed here.

Photo courtesy of Jomphong on

First, choose a birth caregiver who is sympathetic to your needs. Midwives are the best choice if you really want a natural birth. Many hospitals have free standing birth centers attached or located within a block or two of the hospital so that emergency care is quickly available in the rare event that it is needed. Studies conducted on midwife birth outcomes is recent years have shown that midwives generally have about a 5 or less percent c-section delivery rate.

This may be because they will not use medications to force labor to happen quicker, they have much more patience, and they do not hook you up to dozens of machines and force you to lie on your back against the pull of gravity. Many hospitals have c-section rates of 50% or higher. When the rate is higher than 15%, even the World Health Organization has said that “CS rates above a certain limit have not shown additional benefit for the mother or the baby, and some studies have even shown that high CS rates could be linked to negative consequences in maternal and child heath.” (The Global Numbers and Costs of Additionally Needed And Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage – World Health Organization 2010 – Background Paper 30- link to it here

It is a difficult challenge but may be possible to find a hospital with similar policies. A hospital like this will allow you to reject pitocin or other labor induction drugs, they will allow you to stand and walk around, eat and drink freely, and do whatever makes you the most comfortable. This is in contradistinction to hospitals that force you into their mould of what your labor should be. Make sure you ask many questions when choosing a hospital. Ask about the policies above, ask your caregiver what their policy is, and be sure to understand that your caregiver may be away on the day of your labor. This is why it is important to ask about the policies of the hospital, since it is likely that is what you will be required to follow when you go into labor. If your hospital allows you to refuse an IV, refuse pitocin, and refuse continuous fetal monitoring, this may be the best hospital for you, the hospital where you are more likely to have a natural birth.

Photo by Serge Bertasius at
For a planned hospital birth, it will help you to also find out their policies on such things as continuous fetal monitoring (an unnecessary practice that many hospitals use for their own liability issues rather than benefits to mother or baby), and administering pitocin or other labor induction methods (these, too, have benefits to the hospital in terms of speeding your labor up without benefit and with potentially harmful effects to mother and baby such as uterine rupture and accelerated heart rate). Induction very often leads to a c-section. Epidurals and other pain medications are also often routinely administered and may have deleterious effects on mother or baby, and often lead to an emergency c-section. The International Cesaerean Awareness Network, ICAN, has provided this link to hospital c-section rates. 

If you do choose to have your baby in a hospital setting, without a midwife, then the best thing for you to do, in addition to finding out their policies, is to hire a birth doula. This is a person who is trained in labor and birth, as well as interventions that are necessary and unnecessary. They will accompany you at the entire labor and birth (however long it takes). They are an independent provider, not a part of the hospital staff, and they answer only to you. They can tell you what the interventions are that the doctor is planning to perform, as well as why they could be helpful or hinder. According to recent studies with patients using doulas compared to those who did not, the c-section rate, as well as the pain-killer and overall intervention rates with doulas were much lower. Doulas do not charge a lot for their services, and most people can afford them. Their underused is mostly because they are a recent addition to the birth provider team that is not very well known as of yet.

Photo by Patrisyu on freedigitalphotos
Prenatal massage therapy is another method that can be used by expectant mothers with high risk complications. Most obstetricians will allow pregnant women to have prenatal massage therapy, even if they have been restricted to bed rest. Bed rest itself will be covered in another article, but suffice it to say that massage therapy helps and does not harm the pregnant woman restricted in this manner. Studies have shown that massage therapy during pregnancy helps improve outcomes, reduces intervention rates, decreases pre and postpartum depression, increases birth weight, and reduces prematurity. The reasons for these effects are not understood, but they have been observed among enough studies to be statistically significant.

In addition to these methods, there are also studies that have shown that moderate exercise, including yoga and walking, help to reduce your chances of having a c-section. This is why almost all midwives and many obstetricians today recommend that their patients attend prenatal yoga classes. I have personally known clients who have taken yoga classes and have had very short and less painful labors.

Since many of the people that you know, such as friends and family members, may have had a c-section, you may not think there is any reason to avoid it. However, the website Aha! Parenting, in their article about c-sections (linked to here ) talks about 8 possible detractions from wanting to have a c-section. Quoted from this article’s list, C-sections:

1. “Are major abdominal surgery with all the attendant pain and possible complications in the following weeks, just when you want to enjoy your new baby?
2. Increase your risk of hemorrhage and infection?
3. Result in a uterine scar and internal adhesions (scarring) that can cause pain and complications for years?
4. Increase your chances of later ectopic pregnancy and difficulty conceiving?
5. Increase your baby's chances of having asthma later in life?
6. Delay your breastmilk coming in, making it so much more difficult to breastfeed that many women give up?
7. Endanger the health of future pregnancies, increasing the chances of low birthweight, premature delivery and stillbirth?
8. Often leave women with medical complaints six months or a year later?”

And finally, what are the elements in yourself that you need to avoid a C-section? You need to be proactive. You need to be willing (or your partner needs to be willing) to conduct interviews with specialists, and to take their advice. You need to interview a multitude of birth providers and attendants, hospital staff, doulas, nutritionists, and others. This is for your benefit, so that you can help yourself to have the best possible birth outcome for both you and your baby. You can also read as many books as possible about pregnancy and birth, such as The Healthy Pregnancy Book, The Thinking Woman’s Guide to a Better Birth, Pushed, and Ina May’s Guide to Childbirth. These books, along with the advice of your caregivers, will help prepare you for the best possible outcome for your pregnancy.