Safe prevention of cesarean section (C-section)

By MICHAEL BURKS M.D., F.A.C.O.G., Central Missouri Physicians for Women, Special to the Tribune
Wednesday, June 10, 2015 at 10:00 am
In 2013, 32.7 percent of women in the United States were delivered by cesarean delivery. For certain medical conditions, cesarean birth can be life-saving for the fetus, the mother or both, and is the safest way of delivery (for example, placenta previa – where the placenta partially or totally covers the opening in the mother’s cervix – which can cause severe bleeding before or during delivery).

The World Health Organization recommends the cesarean section rate should not be higher than 10-15 percent. The biggest factor in preventing cesarean delivery begins with avoiding the first, or primary, cesarean.

The most common indications for primary cesarean section delivery include, in order of frequency: labor dystocia (difficult or abnormally slow progress of labor), abnormal or indeterminate fetal heart rate tracing, fetal malpresentation (an abnormal position of the fetus in the birth canal), multiple gestation and suspected fetal macrosomia (a baby who is significantly larger than average).

In March 2014, both the American College of Obstetrics and Gynecologist and Society for Maternal Fetal Medicine developed recommendations entitled “Safe Prevention of the Primary Cesarean Delivery.” The following are a few, of many, ways of decreasing the likelihood of having your first cesarean:

1. Decrease elective inductions. Before 41 0/7 weeks of gestation, induction of labor generally should be performed based on maternal and fetal medical indications – not electively. Don’t ask to be induced!

2. Cesarean delivery to avoid potential birth trauma should be limited to an estimated fetal weight of at least 5,000 g (approximately 11 lbs.) in women without diabetes and at least 4,500 g (approximately 10 lbs.) in women with diabetes. Patients should be counseled estimates of fetal weight, particularly late in pregnancy, are imprecise.

3. Women should avoid excessive weight gain during pregnancy using the IOM maternal weight guidelines (25-35 lbs. for women of normal weight, 15-25 lbs. for overweight women and 11-20 lbs. for obese women).

4. Perinatal outcome of a twin pregnancy in which the first twin is head down does not improve with a cesarean delivery. Women should be counseled to attempt vaginal delivery.

5. Continuous labor and delivery support. I often recommend choosing one or two people to come to the prenatal visits and discuss ways of providing emotional and physical support before, during and after your birth.

There are many other recommendations your healthcare provider can follow, including allowing more time for labor and pushing, fetal heart rate monitoring and breech babies. Choose your healthcare provider carefully – someone who advocates for your birth choices. Only you and your healthcare provider can discuss personal risks and options.

I look forward to meeting you – have a safe, uncomplicated and memorable birthing experience.

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