Tips & Tools: C-Section

If my doctor or midwife suggests a c-section, how should I decide if it is right for me?

Is it possible to safely prevent a c-section?

• Choose a caregiver with a low c-section rate. Research says a c-section rate can be safely around 15%. Midwives and family practice doctors generally have lower c-section rates than obstetricians. Choosing a Caregiver has more information.
• Choose a birth setting with a low c-section rate. Research suggests that the same woman might have a c-section at one hospital but a vaginal birth if she gave birth at another, just because of the different policies and practices of those hospitals. One of the most effective ways to lower your chance of having a c-section is to have your baby in a setting with a low c-section rate. Choosing a Place of Birth has more information. Links to c-section rates for hospitals in selected states can be found in Resources: C-section.
• Arrange to have continuous labor support from someone with experience, like a doula, who can help with comfort and good labor progress. Labor Support has more information.
• Get extra rest if possible at the end of pregnancy, to be ready for meeting the challenges of labor.
• Don’t have an induction of labor unless there is a medical reason. Induction of Labor has more information.
• If you plan a hospital birth, work with your care provider to wait until labor is well under way (active labor) to go to the hospital.
• If you had a past cesarean, choose a care provider, and birth setting, supportive of vaginal birth after cesarean (VBAC) and decide together what is right for you this time. VBAC or Repeat C-Section has more information.
• If your baby is in a buttocks- or feet-first position (breech) near the end of your pregnancy, ask your doctor or midwife about turning the baby to a head-first position (external version).

When having a cesarean section, what are some tips for having a safer and more satisfying cesarean delivery?

• Participate fully in decisions about the birth: The difficulty or ease of the birth and whether the baby was born vaginally or by cesarean have little to do with how women feel about the birth. Women are most likely to feel satisfied with their births when they feel a sense of accomplishment and personal control and when they have a good relationship with caregivers. A good relationship includes such elements as being treated with kindness and respect, getting good information, and having the opportunity to participate in decisions about care.
  
• If you are having a scheduled c-section, wait until at least 39 weeks unless there is a medical reason to have your baby sooner. The last days and weeks of pregnancy are important for the baby’s lungs, brain, and other organs to develop. Babies born before 39 weeks may need special care and have continuing problems if they are born before they are ready.
• Ask for antibiotics at the time of the cesarean. Antibiotics reduce the chance of infection. You do not need them afterward unless you develop an infection.
• Ask for your uterus to be closed with two layers of stitches (double-layer uterine suturing). Some studies show this makes labor safer if you have other babies in the future.
• Request care after surgery to reduce the chance of blood clots. Depending on how likely you are to have this problem, prevention might include wearing inflatable devices on your legs, prescribing medication, or both. It is also important to get up and walk soon after the operation.
• Work with your care provider to carry out your preferences. For example, you might want to have pictures or video of the birth, have the doctor or a nurse explain what is happening during the surgery, or let you discover your baby’s sex before they announce it.
• Have your baby and your labor companions with you in the recovery area. Holding and breastfeeding your baby soon after delivery helps both you and your baby get started on the right foot and may avoid problems with breastfeeding.
• Have your partner able to be with your baby in the nursery. This includes the newborn intensive care nursery. If your baby must be separated from you because of concerns about the baby's health, it will be comforting to know that your partner can be there for your baby and can bring you word of your baby's condition.
• Ask for extra help with breastfeeding. Because you are recovering from surgery, it can be challenging to get breastfeeding off to a good start. But women who have plenty of support can overcome these early challenges. You might need to ask your provider for a referral to a lactation consultant.
• Plan for extra help at home. Even after you go home, you are still recovering from surgery. It may be difficult or painful for you to walk for long periods, and your care provider will probably advise you not to drive or lift anything except your baby. Say yes when family, friends, or neighbors offer to help and keep a list of things they can do around the house. If possible, have a family member stay with you for several days after you get home.