What about Cesarean Birth?: A BFW Perspective

This piece on cesarean birth is a modified excerpt from Ancient Map for Modern Birth by Pam England. To read more (and see the full list of citations), buy your copy here.Many pregnant people know and accept that cesarean birth may become necessary and do not resist learning more about it or considering the possibility, even if they don’t want to have one. Others actively avoid thinking about cesareans out of a misguided attempt to prevent a cesarean from happening. Their birth support team may even reinforce this risky approach. Unfortunately, neither wishful thinking nor a strategy of avoidance prevents cesarean surgery—nor any other unwished-for outcome. They do, however, increase the chances that the birthing person will be unprepared if a cesarean actually happens.If you have been avoiding the topic of cesarean birth, begin exploring what is motivating you to avoid learning about, or talking about cesareans and how you can prepare for this scenario should it occur. Consider the following...

What have you already done to decrease the likelihood that a cesarean might happen? What do you want to know about cesarean birth? What do you want your birth attendants to know if you have a cesarean? How do you envision getting through a cesarean—what would you want or need?

Decreasing the Likelihood of Cesarean

Before delving into the details of cesarean birth, take some time to notice what you are already doing to decrease your chances of having a cesarean. Many people who birth by cesarean have, indeed, done “everything right,” but the cesarean birth fairy—the unexpected—paid a visit anyway.

Some steps you can take during pregnancy to decrease the risk of having a cesarean

• Stay healthy, eat well, and exercise frequently during pregnancy.
• Find out the cesarean rates of potential birthplaces and birth attendants in your community.
• Choose your birth attendants mindfully.
• Learn pain-coping practices to help you persevere during tough moments and a long labor.
• Rest your body and your nervous system by walking in nature, dancing, doing yoga, meditating, creating art, working through fears, and more.
• Be in optimal position as often as you can during your third trimester and in labor.
• Have excellent continuous labor support, ideally from a skilled doula.
• Know when and how to ask questions to determine when medical support or induction is necessary.
• Labor at home as long as you can.
• Labor and push in a variety of positions.
• Get a second opinion when in doubt about a recommendation for a cesarean.

Being patient may prevent a cesarean

Although one in every three first births “stalls” in active labor, this does not mean a cesarean is inevitable. About one out of every three of these laboring parents go on to achieve a normal vaginal birth.

Nonetheless, in our birth culture a lack of progress for two or more hours increases the risk of cesarean by up to sixfold.Research and new ACOG statements strongly support the idea that patience is the number one way to decrease the cesarean rate. It is estimated that “watchful waiting” alone could eliminate 130,000 cesareans a year in United States. Parents, nurses, and doctors all need to become more comfortable with waiting when labor hasn’t started “on time” or isn’t progressing as quickly as hoped. If your labor stalls, rather than consenting immediately to a cesarean consider various alternatives such as waiting and doing something different, such as hydration by IV; changing positions; or having an epidural to rest. (See chapter 31 for more about stalled labor.) 

Preparing for Cesarean Birth

Giving birth by cesarean means having major abdominal surgery, a reality that cannot be downplayed. While we may be able to use intuition as a guide through natural labor, we don’t have an internal map for cesarean surgery. Even when a cesarean is medically necessary and a parent consents to surgery, it is not necessarily something they “choose.” For this reason, as soon as the decision is made many people, feeling they have lost control, give up participating emotionally and just wait for the birth to be over, hoping their baby is okay...Read more about how to prepare for the possibility of cesarean birth, and, should a cesarean become a part of your birth experience, what you and your birth partner(s) CAN do to have a more mindful, family-centered cesarean in Ancient Map for Modern Birth.