Sometimes, your birth doesn’t always go as planned. If you’re pregnant, you’ve probably already discussed with your doctor your ideal birth plan: maybe you want to go “all natural” without any drugs or medical interventions, or you desire a water birth. Perhaps you are experiencing a higher-risk pregnancy and already know a Cesarean section is in your future. A new report from the Centers for Disease Control and Prevention on C-section rates, along with a study on issues with other delivery methods, may ease your concerns.
Below, we’ll go over some key points of recently published data on which states have a high C-section rate and why, how to avoid a C-section, and a quick breakdown of the risks and benefits of various delivery methods. As always, you’ll want to discuss your delivery method with your birth team.
Childbirth Methods: Risks and Benefits
First, let’s talk about the types of childbirth methods and their associated risks and benefits. As mentioned above, there are a few different ways you can deliver your baby, split between a C-section and a natural birth. In some births, vacuum extraction or forceps are used. In the U.S., 32% of all deliveries are by Cesarean, with 1.27 million babies born this way in 2015. By comparison, 2.7 million babies that year were born via vaginal delivery.
The following is an overview of these methods, along with risks and benefits for each (please note that this information is not intended to be comprehensive, so be sure to ask your doctor any questions you may have):
Generally, your doctor team will know any risks that arise when you’re delivering your baby vaginally, but the benefits include shorter hospital stays, lower infection rates, quicker recovery, and fewer respiratory problems for the baby.
While most babies were born outside of hospitals in 1900, the rate of hospital deliveries increased from 1940 through the late 1960s. Maternity suites have become all the rage in our high-tech world now, but water births also have consistently trended for the past three decades.
For more information about water births, check out our informative post about the benefits and risks here: Water Births: Are They Safe?
If you plan to have a vaginal delivery, you’ll want to decide whether you’ll give birth to your baby in a hospital, at home, or in a birthing center. We offer more tips on how to decide in this post: Where Should I Give Birth?
A C-section is the delivery of a baby through a surgical incision in the abdomen and uterus of the mother. They’re most common for women who are having multiples, a large baby, a baby in breech position, who have placenta previa or a large obstruction, or who have had previous C-sections.
Some women elect to have a C-section ahead of time even if it’s not medically necessary. However, the American College of Obstetricians and Gynecologists does not recommend C-sections by choice for women who are less than 39 weeks pregnant or who plan to have several children. That said, a vaginal delivery is possible after C-section: 75% of women have been able to do this successfully.
Vacuum extraction and forceps delivery
While C-sections are inherently risky as being a method in response to a complication, some C-sections are planned in advance so you have time to discuss your options and concerns with your doctor. With vacuum extraction or forceps deliveries in a natural birth, which help guide baby out of the birth canal, you’re risking possible nerve or brain damage to your baby. Although both tools are generally safe, your baby could have a higher risk of developing jaundice or serious birth trauma. Jaundice is often mild but more serious cases can lead to brain damage or acquired cerebral palsy.
According to a new study published in the Canadian Medical Association Journal, midpelvic forceps and vacuum deliveries lead to a higher rate of maternal and infant trauma than C-sections:
In deliveries that did not involve fetal distress, severe complications for the baby were 80% higher following midpelvic forceps and midpelvic vacuum compared with cesarean delivery. The rate of severe birth trauma was five- to ten-fold higher in deliveries by midpelvic forceps and midpelvic vacuum compared with cesarean delivery. Severe obstetric tearing occurred in 19% of women delivered by midpelvic forceps, 12% of women delivered by midpelvic vacuum, and 20% of women that delivered using a combination of midpelvic vacuum and forceps.
While all that sounds scary, the good news is that medical advances have allowed the infant mortality rate to continue to decline over the past few decades. Since 1975, it’s decreased 63%, from 16.07 to 5.9 deaths per 1,000 live births.
How do I avoid a C-section?
A few states seem to know something the rest of us don’t: they’re doing great at keeping their C-section rates low, with Utah having the lowest in the nation. But how?
Just 22.3% of women who gave birth in 2016 in Utah had C-sections, down from 22.8% the year prior, according to the National Vital Statistics System. That’s also much lower than the national C-section rate of about one-third of pregnancies. Utah also has a lot more births per 1,000 women, too — 78 compared to the national average of 62.5. The overall U.S. birth rate declined 1% in 2016, though the preterm birth rate rose 2%.
Some reasons for Utah’s low C-section rate may include lower obesity and sexually transmitted infection rates and fewer diabetes incidences than the rest of the U.S., as all of those factors increase the chance of a C-section in pregnant women. Utah also has more women getting prenatal care than the national average, while a lot of women deliver at home (a Consumer Reports study notes that your risk of having a C-section can be nine times higher depending on what hospital you choose).
Although Utah has a low C-section rate, the World Health Organization says one between 10-15% is optimal for the best birth outcomes in a society. So, what are some ways we can avoid a C-section? The following are tips from the American Pregnancy Association:
- Find a healthcare provider with low rates of intervention and ask about their C-section rate/philosophy
- Be flexible with your birth plan and stay educated with birth classes (particularly, learn about breech delivery)
- Get labor support from a professional, like a doula
- Prolonged labor at a hospital can increase your chance for a C-section, so ask your healthcare provider how long you can delay a trip to the hospital once labor begins
- Avoid induction and epidural analgesia if possible; explore options for coping with pain and find laboring and pushing positions that work for you
- Avoid continuous electronic fetal monitoring while in labor
Get Help with a Birth Injury
While the above tips may help, sometimes complications arise and it’s not always possible to have a natural birth. Even women who attempt natural birth may need assistance from tools such as vacuum extraction or forceps, which carry their own risks. If your doctor was negligent during your childbirth and you or your baby suffered as a result, you have legal options. Safe Birth Project may be able to help. Contact us today for a free consultation.
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