How to prevent a primary Cesarean

Reasons for a Cesarean

⁃ 34% of Cesareans are performed due to ‘labour dystocia’ (= lack of progress/ descent/ dilation or difficult labour)*. These are common scenarios: Baby is floating high above the pelvic inlet and not engaging in spite of regular contractions. Or baby might descend into pelvis but labour stalls once baby has reached a certain level (such as midpelvis or pelvic outlet) due to poor flexion of the head or malposition for example. A labouring mother might even fully dilate but if baby is not coming down into or through the pelvis a Cesarean becomes necessary.

There is no magic formula for all women but most women will save themselves many hours/ days in labour (and much pain!) by receiving personalised chiropractic care in pregnancy and learning exercises and techniques to encourage optimal fetal positioning (Spinning Babies®) so that there is a higher chance that baby engages well. (If you’ve had any accidents or trauma around the pelvic region/ lower back/ pelvic floor this is especially important for you to know.)

Dietary and lifestyle choices also play a big role in avoiding labour dystocia as well as choosing a care-provider who offers evidence-based and women-centred care that is not only hands-on and continuous, think midwife who knows you well and is there for you throughout your entire pregnancy, birth and postpartum journey (we’re not meant to give birth with strangers!), but also skilled in facilitating physiological birth. This is not the same as having a ‘minimising risks’ approach which is largely based on fear (Adrenalin/ stress/ fear inhibits normal labour and birth!)

⁃ ‘Non-reassuring fetal heart tones’ is the second most common reason (23%) for first-time Cesareans*. “Cochrane researchers combined the results of 12 randomized, controlled trials with more than 37,000 participants. Mothers were randomly assigned to receive either continuous EFM or hands-on listening during labor (ie. fetal stethoscope/ doppler). The researchers found no differences between groups in Apgar scores, rates of low-oxygen brain damage, admission to the neonatal intensive care unit, and stillbirth or newborn death. They also found that people in the continuous EFM group were more likely to have a Cesarean and more likely to experience the use of vacuum or forceps when compared to those in the hands-on listening group.“
(Source: Evidence Based Birth)

So more technology does not make birth safer. In fact, there is research showing that home births are as safe as hospital births (maybe even safer).
Dr. Neel Shah, MD, MPP, FACOG says that

The greatest influence on whether a birthing person has a cesarean is which door they walk through when in labor. It’s not baby’s size, being due or overdue, or even if they have a risk factor, such as gestational diabetes. The variation in hospital cesarean rates is so great that the hospital itself becomes the risk factor for major surgery. The variable for whether a vaginal birth is possible has become the address where the labor occurs.

⁃ The third most common reason to perform a Cesarean is ‘fetal malpresentation’ (17%). As I said above there is not one solution for every motherbaby but most women will be able to resolve this issue with appropriate bodywork and optimal fetal positioning when started early in pregnancy (so if you’ve been thinking about a doula please get in touch now!).

⁃ 4% of all Cesareans are performed due to ‘suspected big baby’ (> 4kg). Many babies that seem ‘too big’ are actually simply unengaged according to midwife Gail Tully, founder of Spinning Babies®. To prevent gestating a big baby conscious dietary and lifestyle choices are crucial during pregnancy. Dr. Gowri Motha’s ‘Gentle Birth Method’ protocol for example has helped many mothers give birth in under 5 h to normal sized babies. 

There is so much you can do to avoid an unnecessary Cesarean. Being educated and informed is key. Having someone work with you one-on-one is vital also.

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 meta-analysis 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 (50%) in the rate of cesarean delivery.*

If you’d like to maximise your birth satisfaction and minimise interventions please
get in touch. I offer free initial consultations in Byron Bay as well as worldwide virtual sessions.

Preventing a primary Cesarean is important but it’s also vital for you to know that there is so much we can do to make a necessary Cesarean beautiful and family-centred. I’m here to support you fully- however labour unfolds.

* Source: American College of Obstetricians and Gynecologists (ACOG)/ Society for Maternal-Fetal Medicine: ’Safe Prevention of the Primary Cesarean Delivery’ (2014)

Nathalie Solis