Tuesday, July 29, 2008

Taken from CNN Five ways to avoid a C section

updated 6:16 p.m. EDT, Thu August 23, 2007
Five ways to avoid a C-section

C-sections rose by more than 40 percent between 1996 and 2004
Many experts think as many as half of all C-sections are unnecessary
Inducing labor increases chances of a Caesarean section delivery
Laboring at home as until 3 centimeters dilated also reduces risk of C-section
Empowered Patient is a regular feature from CNN Medical News correspondent Elizabeth Cohen that helps put you in the driver's seat when it comes to health care.
ATLANTA, Georgia (CNN) -- When Barbara Stratton of Baltimore, Maryland, looks back at the birth of her son, Charlie, now 7, she's angry -- angry she had a surgery she believes she didn't need.

Babies delivered by C-section are at higher risk for complications, including breathing problems.

Stratton said her obstetrician induced labor a week before her due date because she feared the baby would be too large to deliver if they waited for Stratton to go into labor spontaneously. But even after being induced, her labor still didn't progress, and Stratton ended up with a Caesarean section. Her baby weighed 8 pounds, 7 ounces -- far smaller than the obstetrician had predicted.
"I never needed the C-section in the first place," said Stratton.

Here's how to avoid having a C-section unless you absolutely need it -- in such medical emergencies as umbilical cord prolapse, which cuts off the baby's oxygen, or placenta previa, when the placenta blocks the cervix so that the baby can't be born naturally.
1. Don't get induced unless medically necessary
Years of study have shown that inducing labor often leads to a C-section.
Klein says studies of first-time moms show that 44 percent of those who are induced end up with a C-section but that only 8 percent of those who go into labor spontaneously end up with a C-section. Doctors say many times, inducing women way before the cervix is ready can lead to unproductive labor, which then necessitates a C-section.
2. Labor at home until you're approximately 3 centimeters dilated
Dr. Elliott Main, director of obstetric quality at Sutter Health in California, said encouraging moms to stay at home in early labor is one way his hospital has been able to keep C-section rates steady while nationally the rate keeps climbing every year.
Why would laboring at home help fend off a C-section?
Part of it has to do with the way mothers feel. "Anxiety can slow down labor," he said.
3. Choose your hospital, and your practitioner, carefully
If having a vaginal birth is important to you, shop for a doctor and a hospital with low C-section rates. "Let's say one hospital has an 18 percent C-section rate, and another one is 45 percent. Which door you walk into will have a profound effect on what happens to you," said Carol Sakala, director of programs at Childbirth Connection, a nonprofit group. You can find out the rates by checking with the doctor's office and the hospital.
4. In the delivery room, ask questions if your practitioner says you need a C-section
Some situations are true emergencies, and a C-section is necessary within minutes to save the baby's life. "That's not a time to negotiate," said Dr. Timothy R.B. Johnson, chair of obstetrics at the University of Michigan. But in other situations, parents should ask questions about whether a C-section is absolutely necessary, he says. For example, if a doctor says the baby is too big to deliver vaginally, "There's a conversation to be had. You can ask, 'Doctor, are you sure the baby's too big? How big?'" Johnson said. "Our ability to guess size is not absolute. I've had babies I thought were 11 pounds that turned out to be 7 pounds. Doctors get humbled on a regular basis."
5. Get a doula
After her own disappointing birth experience, Barbara Stratton became a doula. Doulas, or birth assistants, can help advocate for a mother when she's in labor. E-mail to a friend
Elizabeth Cohen is a correspondent with CNN Medical
This article has been edited and highlighted.

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