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Epidural Risks
Childbirth after Cesarean
Benefits of Choosing a Midwife
EFM confines a woman to bed [link widoczny dla zalogowanych], which makes labor more painful (inviting pain interventions) and keeps the mother from finding the necessary positions to help her baby move into the correct position for birth. It is also distracting to the support team; they find it difficult not to focus on the numbers, jumping lines and beeps of the machine rather than on the birthing woman.
If your care provider insists on using EFM, tell her you will allow it intermittently (for example, 10 minutes once every hour). A better option is to use a stethoscope or Doppler at regular intervals to check the baby’s heart rate. It is just as safe and effective without raising the C-section risk.
It stands to reason that if a woman’s body isn’t ready to give birth, attempting to force it to do so will sometimes fail. This is especially true of a first-time mother. Many women who go into labor naturally have cervixes that are already partially effaced and/or dilated. Their labors are shorter and their contractions more effective at pushing the baby down and out.
Interventions during labo
Choosing a Doctor or Midwife
Most midwives will have a more natural approach to birth than doctors, but this is not always the case so don’t make any assumptions. There are Certified Nurse Midwives who are very medical in their approach to childbirth and there are doctors who believe in letting nature take its course.
Induction Increases Risk of C-section
The rate of Caesarian births in the U.S. is currently over 31% (Rita Ruben, “Answers Prove Elusive as C-section Rates Rise”, USA Today, 2006). This is not because one in three women cannot birth a baby naturally; rather it is the result of medical management of labor among other things. Many common birth interventions create what professionals call a “cascade of interventions” with the ultimate intervention being a C-section. If you want to give yourself the best chance of avoiding a surgical birth, here are a few things you can do.
Some hospitals prefer to use continuous electronic fetal monitoring (EFM) on all of their patients. It is meant to monitor the baby’s well-being and improve outcomes, but it has statistically led to more C-sections and no improvement in babies’ health. ("Routine Electronic Monitoring Of Fetuses Is Challenged in Study," Warren E. Leary [link widoczny dla zalogowanych], New York Times, 1995)
The single most important thing you can do to avoid a Caesarian section is to put yourself in the care of a professional who does not do them lightly. When interviewing care providers, ask what their Caesarian rates are. If they are over 10% for non-repeat C-sections, you may want to keep looking. If you are a Vaginal Birth After Caesarian (VBAC) candidate, ask about those rates.
Continuous Electronic Fetal Monitoring Increases C-section Risk
Some care providers like to induce shortly after a woman passes her due date or because the baby is suspected to be big. You can refuse inductions for these reasons and convince your care provider to monitor the baby’s well-being until you go into labor on your own. Late ultrasounds and belly measurements are not reliable ways to predict a baby’s size in late pregnancy.
Minimize Birth Interventions
On top of the rate itself, talk to the care provider about his or her philosophy of birth. Does she follow the model of active management of labor or does she sit back and let things progress on their own? Does he induce 3 days after your due date [link widoczny dla zalogowanych], or does he wait 2 weeks as long as both you and the baby are doing well?