Nearly a quarter (21.5%) of pregnant women had their first cesarean section in the US. Cesarean section can overcome births accompanied by medical complications, and save the lives of mothers and babies due to emergency conditions during childbirth. However, many experts believe that this operation is performed too often, and sometimes for avoidable reasons. If you want to avoid the greater risks and longer recovery period from a C-section, there are several ways that can increase your chances of having a vaginal delivery.
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Part 1 of 3: Finding the Right Pregnancy Care
Step 1. Consider seeking the services of a licensed midwife
Some women are able to deliver their babies under the care of an obstetrician, but research shows that midwives are more successful in guiding normal deliveries without unnecessary interventions such as caesarean sections. Make sure the midwife you choose has an official license to practice before using his services. A midwife with an official license to practice has graduated from a midwife education recognized by the government and professional organizations in the territory of the Republic of Indonesia and has the competence and qualifications to be registered, certified and/or legally licensed to practice midwifery.
- Midwives are not trained to perform surgery or handle high-risk deliveries, but most midwives are affiliated with hospitals or maternity clinics. Be aware that if you experience complications during labour, your midwife should take you to an obstetrician. Talk about possible birth complications with your midwife before your due date (HPL), and add a note to your birth plan about what to do if complications occur.
- Ask the midwife who cares for you how often she does episiotomy. An episiotomy is a medical incision made during the third trimester to widen the vaginal opening through which the baby will pass. This procedure is being done less and less, but you should ask your midwife if she still practices it.
- Midwives generally do not use equipment such as forceps or vacuums, as they are not trained to use them and are generally not allowed to do so either. However, be aware that the equipment can save the lives of both mother and baby and prevent cesarean sections.
- Midwife patients generally require less pain medication (although some midwives are unable to administer medication or anesthesia, and this also impacts the amount of pain medication their patients take). After delivery, midwife patients reported feeling happier with the experience.
- If you have a high-risk pregnancy, such as having twins or triplets, or if you have gestational diabetes, high blood pressure, or chronic health problems, it is not recommended that you use the services of a midwife without an obstetrician.
Step 2. Ask the gynecologist about the cesarean section policy
If you prefer to use the services of an obstetrician over a midwife, be sure to choose a doctor who respects your desire for a vaginal birth. Ask where the doctor will assist your delivery: are you confined to a particular hospital, or are you given other options, such as a maternity clinic? More flexible conditions will make you more able to control the way you give birth.
Ask your doctor for "percentage of first-time caesareans." This percentage represents the first cesarean delivery performed by a doctor. This figure should be as small as possible, ideally around 15-20%
Step 3. Find a doula for additional support
Doulas are non-medical professionals who can be asked to help accompany you to the hospital or maternity clinic and provide other assistance during the delivery process. Doulas are not medical professionals, but their guidance and support can help speed up labor with fewer complications and a lower percentage of caesarean sections.
- Recent research has shown that many pregnant women are unaware of doula services, and as a result, are not benefiting from it. Ask a doula recommended by an obstetrician, or seek advice from other mothers. Some maternity clinics offer doula services as part of their overall maternity service.
- Keep in mind that doula services are usually not covered by health insurance, and costs can vary from a few hundred thousand to several million rupiah.
Step 4. Take a natural childbirth class
Find out more about how to avoid a C-section by taking natural childbirth classes that focus on breathing techniques and giving birth without intervention or the use of painkillers. You will learn how to manage pain naturally with positioning and breathing exercises that will reduce the need for medical intervention, including a cesarean section.
If you gave birth in a maternity clinic or hospital, ask for a referral to a natural birthing class. Your doula may also be able to recommend childbirth classes, if you use their services
Part 2 of 3: Changing Your Diet and Exercise
Step 1. Live a healthy and balanced diet during pregnancy
Labor and delivery is very physically demanding, and you have to be able to go through the challenges. Following a healthy diet rich in protein, fruit, vegetables, and complex carbohydrates will help prepare your body as much as possible ahead of time.
- Obesity is one of the biggest risk factors for caesarean section. Optimizing your pre-pregnancy health by limiting weight gain through exercise and a healthy diet can help lower your chances of having a C-section.
- Follow a balanced diet that includes 4 food groups: fruits and vegetables, protein, dairy products, and cereals.
- Make sure your daily diet consists of 5 servings of fresh or frozen fruit, 170 grams or less protein such as meat, fish, eggs, soybeans, or tofu, 3-4 servings of frozen or fresh vegetables, 6-8 servings of cereals such as bread, rice, pasta and breakfast cereals, as well as 2-3 servings of dairy products such as yogurt and hard cheese.
- Maintaining a healthy weight for your age and body type is also important. Do not be underweight or overweight during pregnancy as this can lead to complications and health problems. You can calculate your body mass index (BMI) using an online BMI calculator and determine how many calories you should consume each day to maintain a healthy weight.
- If in doubt about your diet, ask your doctor or midwife for specific advice. If you have gestational diabetes or other complications, you will need to specifically follow additional dietary guidelines.
Step 2. Exercise during pregnancy
As long as your doctor or midwife allows it, light-intensity exercise will also keep you fit and prepare you for labor.
- Do light intensity exercise such as swimming, walking, and yoga. You can also do special exercises for pregnant women such as abdominal exercises.
- Avoid sports that require you to lie on your back during the first trimester, as well as contact sports, and activities that put you at risk of falling, such as skiing, surfing, or riding.
Step 3. Get plenty of rest, especially during the third trimester
Giving birth in a fit condition will make you better able to face the physical challenges without the help of intervention. Most pregnant women need more sleep than they think because their bodies support fetal development and are more tired than usual.
Finding a comfortable and safe position for the baby to lie in during pregnancy can be a little difficult. Try lying on your left side while bending your legs. You can use a body pillow or several lower back support pillows for a comfortable sleep
Step 4. Practice prenatal yoga
Prenatal yoga has been known to improve sleep, reduce stress or anxiety, and increase the strength, flexibility, and muscle endurance necessary for a smooth delivery. Prenatal yoga can also reduce the risk of preterm birth, and delivery problems that can result in a C-section.
During a typical prenatal yoga class, you'll learn breathing techniques, light stretches, and postures that can improve balance and flexibility. You will also be given a cool down and relaxation time at the end of the class
Part 3 of 3: Avoiding Unnecessary Interventions During Labor
Step 1. Don't go to the hospital until your labor is in an active phase
Arriving too early to the hospital in the early stages of labor can lead to unneeded interventions, including a caesarean section.
The first phase of labor is the longest, with mild contractions. Walking, standing, and squatting during this phase will help promote a healthy and normal labor until it enters the active phase. This phase of labor often occurs later than doctors expect, when your cervix is at least 6 cm dilated. Staying at home until you enter the active phase and require medical intervention can ensure you have a normal delivery
Step 2. Avoid induction during labour
In some cases, induction of labor with drugs or equipment to induce labor is medically necessary. However, as long as you and your baby are doing well during labour, induction is best avoided. Research shows that induction during labor can increase your chances of having a cesarean section by up to 2 times.
Try to avoid "elective inductions" that are done on the basis of convenience, not necessity. It's a good idea to ask your partner for help during labor or a doula, and use the breathing and delivery techniques you learned during your birthing class to make labor easier
Step 3. Ask your doctor for options for pain control
The evidence for whether epidural injections can increase the chances of a cesarean section is debatable. An epidural injection given too early in labor can increase your chances of having a C-section, but a low-dose spinal epidural (CSE) or epidural injection can relieve pain without numbing it and make it easier for you to push. Discuss the benefits and risks of painkillers with your doctor or midwife so you can decide which option is most appropriate for you.
- Epidural injections can impede the baby's ability to move in the womb, so if it's in the wrong position, your baby will have a hard time changing into a better position during delivery. When you have an epidural injection, your ability to move is also limited, which can lead to complications during delivery.
- You may be able to reduce the increased risk of needing a C-section by waiting until the opening 5 before using an epidural or other pain reliever medication. At that point, the chances of your labor slowing down or stopping are less. Keeping moving during the early stages of labor by walking around and changing positions can also help. Avoid lying on your back as this position can make it difficult for your baby to move into the right position and prolong your labor.
Step 4. Learn how to flip a breech baby from an obstetrician or midwife
A breech baby is positioned upside down (legs or buttocks first in the womb), and if not changed can lead to complications during delivery. If the baby is in a breech position at about 36 weeks of gestation, the doctor or midwife can show a hand movement on the abdomen to turn the head down. By ensuring the baby is in a good position for delivery, this movement can reduce the chance that a cesarean section will be needed.
If the baby is in the wrong position during labor and has difficulty passing through the pelvis even though the position has been shifted with hand movements, the doctor may use forceps or a vacuum as a safer option than a cesarean section. Talk to your obstetrician about this procedure and state clearly in your birth plan if you prefer this procedure over a cesarean section
Step 5. Tell your partner about your desire to have a vaginal birth
If you ask your partner to accompany you in the delivery room, make sure he or she knows you want a vaginal birth. As such, it can provide effective support during your contractions, remind you of your goals, and strengthen you when you're exhausted.
