Can You Reduce the Likelihood of Requiring a C-Section? (The Answer May Not Be As Simple As You Think!)

By Jessie Mundell
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Giving birth is a major, life-changing experience, and a C-section procedure is itself a major abdominal and pelvic surgery. For a growing number of women, safely avoiding a C-section is a top priority.

But… is there anything a woman can do to avoid a C-section?

Of course, nothing is guaranteed and birth is extremely unpredictable, but research and experience from birth professionals does suggest that while completely avoiding a c-section just isn’t possible in some cases, there are specific actions you can take to reduce the likelihood of requiring a C-section.

prevent-csection-jessie-steele-350x350At Girls Gone Strong, we fully support any method of birth that keeps moms and babies safe and healthy. By no means are we implying that a C-section birth is lesser or worse than a vaginal birth.

C-sections are not bad, and your body has in no way let you down if a C-section is the necessary—or chosen—birth outcome. We simply want moms to have the best birth experience possible, and if the safe prevention of a C-section is important to you, you’ll be interested in the information to follow.

I’m writing this article as a first-time mom who had an emergency C-section after a long labor and a baby in distress. I focused on all the factors I’ll discuss below, and a C-section ended up being the absolute best birth outcome for my baby.

In 2011, about one third of pregnant women in the U.S. gave birth by C-section. This is a 60 percent increase since 1996.

While C-section births are absolutely necessary in some cases (thought to be 10 to 15 percent), there is widespread concern that C-section deliveries may be overused.1 In the U.S., first-time moms account for almost 60 percent of all cesarean births, and attention is turning toward the safe prevention of first-time moms having C-sections.

Recovery from a C-section can be difficult, particularly since this most intense healing time for the mom coincides with caring for a newborn.

If avoiding needing a C-section is a priority for you, please understand that, as mentioned above, birth can be very unpredictable, and despite “doing everything right,” having a C-section may end up being what’s best for both you and your baby. That being said, the following three factors can reduce your likelihood of needing a C-section.

1. Regular Exercise in Pregnancy

Studies suggest that regular exercise in healthy pregnant women seems to increase the likelihood of a vaginal birth. A study published in the American Journal of Obstetrics and Gynecology found that structured physical exercise during pregnancy reduces the risk C-section 2, and a review of research published in Acta Obstetricia et Gynecologica Scandinavica concluded more specifically that regular low-to-moderate levels of physical activity in pregnancy appear to increase the likelihood of a vaginal delivery.3

Exercise in pregnancy is excellent for general health, unless specific contraindications exist. For example:

  • Incompetent cervix
  • At risk for preterm labor
  • Placenta previa
  • Persistent vaginal bleeding
  • Ruptured membranes

The general guidelines for exercise in pregnancy suggest at least 150 minutes per week of moderate intensity physical activity, though you can absolutely do more physical activity, if that feels good for you. Strength training and cardiovascular activities are both encouraged. 4,5

prevent-csection-half-kneeling-row-pregnant-284x375One particular study, published in Women’s Health Issues (the official publication of the Jacobs Institute of Women’s Health), found that exercising for 150 minutes or more per week was associated with a decreased risk of C-section when compared with less than an hour of exercise per week.6

I recommend doing a full-body strength training routine two to three days per week throughout pregnancy. This will not only help you maintain (or gain) muscle mass, it also allows you enough flexibility to safely incorporate exercise into your week, and gives your body adequately rest and recovery between sessions.

You can also do moderate-intensity cardio two to three times per week such as faster paced walking, hiking, biking (indoor or outdoor, if you’re comfortable with that at your stage of pregnancy), rowing, or swimming. In addition, light cardiovascular activities, such as leisurely walking, can be done daily.

The most important goals of exercise in pregnancy are to keep you as comfortable as possible, to maintain a good fitness level, and to help you recover postpartum.

2. A Supportive Birth Team and Place for Birth

Two of the most important decisions a woman must make in pregnancy as she prepares for labor and birth are:

  • Who will make up my birth team?
  • Where do I plan to birth my baby?

prevent-csection-jessie-labor-450x338Having continuous support during labor from your healthcare professionals, and anyone else you choose to have by your side, will help keep you engaged, calm, encouraged, and motivated. Creating an environment—whether at the hospital, home, or birthing center—that helps you feel as comfortable and as calm as possible is part of these considerations.

Some questions you may want to ask your birth team include:

What is your percentage of C-section deliveries?

It’s useful to know how many of your doctor’s previous patients deliver via C-section. For example, do C-sections make up 15% or 60% of their births?

You might also want to ask when your doctor will consider you to be ‘overdue’ and if/when they will want to induce you into labor at a specific time near the end of pregnancy.

What is the percentage of C-section deliveries at this hospital/birth center?

In addition to a doctor’s rate of C-section births, there is a significant difference in the rate of C-section births from hospital to hospital, so you may want to inquire. A publication by American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, reports that rates can vary from 7.1% to 69.9% in the C-section delivery rate across hospitals in the U.S.7

Do you observe a specific length of time within which you’ll allow me to labor before recommending C-section?

New guidelines geared toward the safe prevention of C-sections for first-time moms state that “slow but progressive labor in the first stage of labor should not be an indication for cesarean delivery.”7 In your prenatal appointments, get clear with your birth professionals on whether or not they have hard and set guidelines. Find out if they allow you to continue laboring if you and baby are both doing well.

Finally, whether you are under Obstetrician and/or Midwifery care, a doula can be a fantastic addition throughout your labor. The results of a study published in the Journal of Perinatal Education suggest that doula support during labor is associated with positive outcomes that have physical, emotional, and economic implications.8 Findings by researchers at Case Western University also show that continuous presence of a doula during labor decreased the likelihood of a C-section.9

3. Fetal and Maternal Positioning

The position in which a mother is carrying the growing baby is referred to as ‘fetal positioning’ and can have an effect on the birth outcome.

You might have heard about babies being head down or in breech. A baby will typically move into head down position later in pregnancy to prepare for labor and birth, with the baby’s head engaging into the pelvis. One of the most optimal fetal position for the start of labor is thought to be Left Occiput Anterior (LOA). In LOA, the baby’s back is on mom’s left side and the baby faces between mom’s right hip and her spine.

Breech, however, is when the baby’s bum is birthed before the head. While it’s certainly possible to have a breech vaginal birth, it is becoming less common for doctors to practice this. If a baby is still in breech and has not flipped to head down in the final weeks of pregnancy, many birth professionals will recommend that a C-section be scheduled.

prevent-csection-inversion-jessie-400x287Maternal positioning involves methods that the mom can use in order to help the baby get into a good laboring and birthing position. One of the best things you can do during pregnancy is try to keep the pelvis well balanced. Meaning, strive for good alignment and posture with your body and keep good flexibility through the hips.

Techniques that can help to keep this balance include:

  • Sitting with the hips higher than the knees
  • Practicing squatting movements and supported deep squats
  • Lots of daily walking
  • Bilateral and unilateral strength training exercises
  • Working towards good alignment with the rib cage stacked over the pelvis (e.g. not constantly tucking the tailbone under or flaring the ribcage upwards)
  • Forward leaning inversions where the bum is higher than the shoulders.10

Spinning Babies is a fantastic source with many great exercises, that can help you understand fetal and maternal positioning in depth.11

While birth is unpredictable at best, there are steps you can take to prepare for the best experience possible. If you follow all the above suggestions and feel like you’ve done everything in your power to safely avoid a C-section, and you still end up needing a C-section, it’s completely OK! I had a great C-section experience, have recovered well, and am back to feeling strong, confident, and pain-free in my body.

Keep your pregnant and postpartum clients safe, healthy, and strong.

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About the author:  Jessie Mundell

Jessie Mundell is a certified kinesiologist and a Precision Nutrition Level 1 coach, as well as an author and mother. She specializes in pre- and postnatal exercise and corrective exercise. Learn more about Jessie on her website and connect with her on Twitter.

References

  1. Molina G., Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, Shah N, Semrau K, Berry WR, Gawande AA, Haynes AB. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Journal of the American Medical Association. 2015;314(21):2263-2270 http://jama.jamanetwork.com/article.aspx?articleid=2473490
  2. Domenjoz I, Kayser B, Boulvain M. Effects of exercise during pregnancy on mode of delivery: a meta-analysis. Am J Obstet Gynecol. 2014 Oct;211(4):401.e1-11.  http://www.ncbi.nlm.nih.gov/pubmed/25965378
  3. Poyatos-León R, García-Hermoso A, Sanabria-Martínez G, Álvarez-Bueno C, Sánchez-López M,Martínez-Vizcaíno V. Effects of exercise during pregnancy on mode of delivery: a meta-analysis. Acta Obstet Gynecol Scand 2015; 94:1039–1047. http://www.ncbi.nlm.nih.gov/pubmed/24631706
  4. Schoenfeld B. Resistance Training During Pregnancy: Safe and Effective Program Design. Strength and Conditioning Journal. 2011. 33(5)67-75  https://www.nsca.com/uploadedfiles/nsca/resources/pdf/certification/quizzes/quiz_pack_articles/october_2011_33.5.pdf
  5. Davies G, Wolfe LA, Mottola MF, MacKinnon C. Joint SOGC/CSEP Clinical Practice Guideline. Exercise in pregnancy and the postpartum period. No. 129, June 2003 http://sogc.org/wp-content/uploads/2013/01/129E-JCPG-June2003.pdf
  6. Tinloy J, Chuang CH, Zhu J, Pauli J, Kraschnewski JL, Kjerulff KH. Exercise during pregnancy and risk of late preterm birth, cesarean delivery, and hospitalizations. Women’s Health Issues: Official publication of the Jacobs Institute of Women’s Health. 2014;24(1):e99-e104. http://www.ncbi.nlm.nih.gov/pubmed/24439953
  7. Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:693–711.  http://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery
  8. Trueba G, Contreras C, Velazco MT, Lara EG, Martínez HB. Alternative Strategy to Decrease Cesarean Section: Support by Doulas During Labor. The Journal of Perinatal Education, Volume 9, Number 2, 2000, pp. 8-13(6)  http://www.ingentaconnect.com/content/springer/jpe/2000/00000009/00000002/art00005
  9. McGrath SK , Kennell JH. A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates. Birth (Berkeley, Calif.) 2008, 35(2):92-97 http://europepmc.org/abstract/med/9639765
  10. Forward Leaning Inversions. http://spinningbabies.com/learn-more/techniques/the-fantastic-four/forward-leaning-inversion/
  11. Maternal Positioning. Spinning Babies. http://spinningbabies.com/learn-more/maternal-positioning/
  12. Trying to Avoid a C-Section. American Pregnancy Association.  http://americanpregnancy.org/labor-and-birth/avoid-cesarean/

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