This was published by ICAN:

The Public Citizen Health Research Group in Washington, D.C. has estimated that half of the nearly 1 million cesareans performed every year are medically unnecessary. With more appropriate care during pregnancy, labor, and delivery, half of the cesareans could have been avoided. Clearly, there are times when cesareans are necessary. However, cesareans increase the risk to both mothers and babies. These are suggestions of things you can do to avoid an unnecessary cesarean and can help insure that your birth experience is as healthy and positive as possible.



BEFORE LABOR

Read and educate yourself, attend classes and workshops inside and outside the hospital.
Research and prepare a birth plan. Discuss your birth plan with your midwife or doctor and submit copies to your hospital or birth center.
Interview more than one care provider. Ask key questions and see how your probing influences their attitude. Are they defensive or are they pleased by your interest?
Ask your care provider if there is a set time limit for labor and second stage pushing. See what s/he feels can interfere with the normal process of labor.
Tour more than one birth facility. Note their differences and ask about their cesarean rate, VBAC protocol, etc.
Become aware of your rights as a pregnant woman.
Find a labor support person. Interview more than one. A recent medical journal article showed that labor support can significantly reduce the risk of cesarean.
Help ensure a healthy baby and mother by eating a well-balanced diet.
If your baby is breech, ask your care provider about exercises to turn the baby, external version (turning the baby with hands), and vaginal breech delivery. You may want to seek a second opinion.
If you had a cesarean, seriously consider VBAC. According to the American College of Obstetricians & Gynecologist, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of woman with prior cesareans can go on to birth their subsequent babies vaginally.


DURING LABOR

Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you.
Continue to eat and drink lightly, especially during early labor, to provide energy.
Avoid pitocin augmentation for a slow labor. As an alternative, you may want to try nipple stimulation.
If your bag of water breaks, don’t let anyone do a vaginal examination unless medically indicated for a specific reason. The risk of infection increases with each examination. Discuss with your care provider how to monitor for signs of infection.
Request intermittent electronic fetal monitoring or the use of a fetoscope. Medical research has shown that continuous electronic fetal monitoring can increase the risk of cesarean without related improvement in outcome for the baby.
Avoid using an epidural. Medical research has shown that epidurals can slow down labor and cause complications for the mother and baby. If you do have an epidural and have trouble pushing, ask to take a break from pushing until the epidural has worn off some and then resume pushing.
Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the hospital, instead of being admitted, walk around the hospital or go home and rest.
Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on you and your baby, and what are your other options.
Remember, nothing is absolute. If you have doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.


This may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All Rights Reserved.

Tags: VBAC, cesareans, resources

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This is all excellent advice. One more thing - do as much as you can to wait until you go into labor naturally and do not get induced. This leads to the use of Pitocin on a cervix that may not be ready. Unless of course there is a medical reason the baby needs to be out earlier. And I would not trust "your baby is too big" unless you have history of large babies. If you wait until u go into labor and walk during labor - your pelvis will open and the baby's head will mold. The chance of this is lessened if you are on your back with an epidural.
The best thing you can do to avoid a cesarean delivery is to stay home.... period. For those who are afraid that something might go wrong and it's safer to be in a hospital, that is simply untrue and a landmark study just published April 15, 2009 shatters any pretense that hospital birth is safer. This study of over half a million midwife attended births, 60% planned home births, 30% planned hospital births (with the rest undecided at the time they went into labor) showed unequivocally that when you compare apples to apples - planned home births attended by midwives with planned hospital births attended by midwives, there is no difference in fetal death or neonatal intensive care admission. Thus there is no reason for anyone with an uncomplicated pregnancy to ever deliver in a hospital. And we know from various other data sources that delivery in a hospital in accompanied by increased neonatal monitoring which in turn increases ultimately unnecessary interventions and results in extremely high rates of maternal and neonatal morbidity (especially if you consider the unnecessary surgical removal of a baby from it's mothers abdomen as a morbidity).

And I agree with Jean's point as well. Do not let anyone induce you without a valid reason - and being 41 weeks or having a "big" baby are most emphatically not valid reasons!

David
For those interested the citation is:

de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02175.x.


BJOG is the British Journal of Obstetrics and Gynaecology
These suggestions are excellent. Although Michel Odent, M.D. has pointed out that we need to focus our efforts on how support the mother in labor, rather than just avoiding c-sections. A cold, traumatic or violent vaginal birth is not necessarily better. So in context with this thread, a mother might focus on finding out what different things the provider will do to support her in the labor process. (For example: allows food and drink during labor, supportive of mother having a doula, provides birthing tub, squatting bar, birthing stool, etc., allows spontaneous pushing in any position the mother feels most comfortable, etc.)

Also, finding out the c-section and induction rates is important. Find the facility with the lowest c-section rate possible (if not staying home). In Alaska we have a birthing center that had only 1 c-section in over 100 births!!
Hurrah to this. It was widely reported in the UK: TV news, national newspapers and many local radio stations.
Interestingly the national guidelines on Caesarean Section published by NICE (National Institute for Health and Clinical Excellence) recommend that all women are told that having a home birth reduces their chance of having a cs, as does having the continual support of another woman. However very few women are ever told this and audits of units' compliance with the guidelines don't include this.
The best way to avoid a repeat C/S in the UK is to have midwifery care only and book a homebirth. This way you avoid the very people (Obstetric Consultants) who cause the majority of C/S in the 1st place. If a homebirth is not an idea you relish, book it anyway as by booking one it will ensure that when you go into hospital you are treated like royality...

If any UK Midwife tells you that you MUST see a consultant, and that you can NOT have Midwifery care only, and/or refuses to book your homebirth, then she should be reported to the NMC at once as these are every mothers legal rights.

Regards

Linda Hinchliffe ~ founder VBAC Information & Support
Mum of 9: 3 x Em C/S, 2 x Hosp VBA>2C, 3 x HWB3C & a Hosp WBA3C.
I just wanted to say don't buy the "baby is too big" both of mine were big babies. My 1st was 10lbs and my 2nd was 10lbs 10oz. I pushed both of them out w/out tearing. Don't let anyone tell you you'll need a cesarean because your baby is big.
Here's a little tongue in cheek thing I wrote - I am in the UK
How to avoid a caesarean
1. Don't get pregnant
2. If you do, don't go near a hospital
3. Don't go near an obstetrician
4. Definitely don't go anywhere near a trainee obs. or house doctor
5. Don’t give birth in February or August when the new trainees come
6. If you must see an obstetrician in labour, see a consultant
7. Give birth Monday-Friday during day time hours when a consultant is more likely to be in the building
8. Ask your midwife which consultant to see
9. If necessary, leave their consulting room, or even their hospital
10. Love your midwife
11. Don't let her leave
12. Choose community midwifery care
13. Move to Peckham (or other area where you will get continuity of care from a small team in pregnancy and during labour)
14. Don't go near a bed
15. Or an electronic fetal monitor
16. Or an epidural
17. Or pethidine (?demarol/meptid in the US)
18. Or anyone who is afraid
19. Or doesn't believe you can do it
20. Find a midwife who has seen a home birth
21. Spend your last few months crawling on all fours to make sure the baby’s back is to your front
22. Spend parts of your labour crawling on all fours
23. Spend your last few months doing hand stands to make sure the baby is not breech
24. If it is breech find an experienced midwife (akin to needle in haystack)
25. Don’t go 10 days past your edd
26. Refuse induction
27. Refuse internal examinations
28. Find water
29. Get in a bath, a shower, or if you're lucky (or at home) a birth pool
30. Walk
31. Dance
32. Kiss
33. Laugh
34. Breathe
35. Stay away from the US
36. and Brazil
37. Move to the Netherlands
38. Don't go to a private hospital
39. Do go to a private midwife
40. Be a man
I am due with my second child in September and my doctor already says she wants to induce me a week early. I am not comfortable with this. I fear it will lead to a c-section. She wants to induce because my first child was a week early at nine pounds, I had a quick labor, and my baby was born blue had to be resesitated. I live only two minutes away from the hospital so I feel like when I do go into labor, I can get there quickly if I need to. My husband is in support of the induction, but I don't know. . .
Ifeel as though...strike that....I know that I had an unnecessary c-section and I am hurt/devastated/and angered about it. My water broke naturally and I didn't dialate right away. I had every known intervention done to my body. I feel aweful that I allowed interventions to be performed on my body. I labored at 2-3 cm for about 31hrs until the Drs said that I had to have a c-section becuase I had failed to progress. Neither I nor my baby were in distress. I wish that I had done more research prior to delivering. I even had a midwife with me during my labor however she was the one who was also pushing the c-section in addition to the Drs! I was tag teamed and couldn't defend myself at that moment. I felt for so long that my body failed me but now I know that the medical staff at the hospital failed to support my request for a natural delivery.
Next time around I am ademant that I will not accept any interventions that my actually stall may labor (such as an epidural). My only concern about not going to a hospital to deliver is if I have uterine rupture. I heard that you can have an ultrasound which will measure your c-section scar tissue. I still need to research this more but apparently the thinner your scar the higher chance that you may have uterine rupture. I am doing to demand that I have this assessment performed...perhaps even before I become pregnant so that I do not need to worry about it as much during my pregnancy.
Also I would like to mention a rather interesting piece of information that my OB/Gyn told me at my follow up appointment - the next time I get pregnant they will not be able to use Pitocin on me becuase it has shown to increase chances of uterine rupture. At least I will not have to worry about being induced! BUT she did say that if I do not go into labor prior to my due date than I will HAVE to have a c-section (so she thinks). Why on earth would I schedule major abdominal surgery around an estimated due date? I don't want to be a difficult patient but I will not merely go along with what people tell me because it is my body, my baby and my birth experience. That I will not budge on.
Thank you for posting this information. I will add it to my 'file' of information that I am gathering.
This is great information and is a good guideline for what issues to include in a birth plan. I think that if a woman is going to give birth in a hospital, like I am going to do, it is important that the caregivers know what the expectations are before the big day. Hopefully the staff will work towards preventing c-section, unless absolutely necessary.

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