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With the skyrocketing number of cesareans in the US, some mothers may feel that a surgical delivery is almost inevitable. But women can influence their chances of a safe and healthy birth and drive down the risk of surgery by considering some important issues before the baby arrives."The number of cesareans performed in the U.S. can give the false impression that this surgery carries no risks," said Marilyn Curl, President of Lamaze International. "Clearly, mothers can't control every factor around labor, but it's important to recognize the factors that can be controlled and make sure each mother has the tools and information she needs to make those decisions."Although cesareans are sometimes medically necessary, the surgery can lead to increased risk of medical complications for babies, including prematurity, breastfeeding difficulties, breathing problems, hospitalization in the neonatal intensive care unit and increased risk of fatality. For mothers, it can lead to dangerous bleeding, infection, blood clots and complications in future pregnancies.Mothers can reduce the chances they will need a cesarean by following these tips:
One of the best ways to reduce a woman's individual chances of delivering by cesarean is to give birth in a location, and with a provider, that maintains low cesarean rates. There is no federal mandate for healthcare providers to report this information, so women need to directly ask the provider or birth setting for those statistics. Parents also need to communicate their desire to avoid a cesarean with the maternity care provider so they can create a birth plan designed to reduce the risk.
Many women are advised to have a cesarean section for reasons that are not supported by medical research. They may be told they are too overweight, too short or too old for vaginal delivery. Others are pushed to have a cesarean because their due date has passed, they have low amniotic fluid, they are making slow progress in labor or they had a cesarean in their prior delivery. All of these justifications merit more research or questioning. Mothers should be prepared to ask what their options are. Questions like "Can we wait a little longer?", "Is my baby in any immediate danger?", and "What are the risks of proceeding with surgery versus without it?" can help facilitate informed decision-making.
When hospitals use medication to induce labor, studies have consistently shown that nearly doubles a woman's risk of having cesarean surgery. Most women who are induced need an IV and a continuous electronic fetal heart rate monitor, which most often confines mothers to bed. "A natural start to labor, and staying upright and mobile during labor is one of the best ways to increase chances of a smooth birth," said Curl. "Too many women are put on a clock and put on their backs. It's no surprise when these women are told they have 'failed to progress.'"
While many women envision a labor and delivery nurse helping them through their contractions, most nurses are caring for multiple women simultaneously and don't have time to devote to one-on-one labor support. Women who bring in their own trained labor support person decrease their chances of requesting pain medication and, ultimately, undergoing a cesarean, according to medical research. The early use of an epidural can result in failure to progress and is associated with increased cesarean rates. Mothers fare better when they bring a loved one or doula to help support them through pain-coping methods, such as changing position and bathing, and are more likely to avoid using an epidural.
Lamaze certified childbirth educators help mothers understand their options and what to expect during labor and birth. "We incorporate the best and most current scientific research into our classes," Curl said. "We do everything possible to ensure mothers and babies have a safe, healthy birth." To find classes in your area, visit www.lamaze.org.
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