BY CAROL WARD, MD

Today’s increased rate of cesarean section is largely the result of actions. Actions taken by some health care professionals, hospitals and insurance companies — and the way society as a whole views birth. We can’t always prevent cesareans — sometimes they’re inevitable and life-saving — but we can certainly go into labor and delivery informed and aware. We can be conscious of society’s attitudes, and attentive to our hopes for and approach to birth.

What Does Society Say About Birth?

Do we (as a society) expect perfection? Our grandmothers sure didn’t. If something goes wrong during labor or delivery, who’s liable? Defensive medicine has definitely contributed to the boost of cesarean sections. One of my colleagues once said, “You never get sued for doing a c-section — just for not doing one.”

Thankfully, cesarean sections have become much, much safer than when our grandmothers and mothers were delivering. Surgical techniques have improved, antibiotics prevent many complications — and with prenatal testing, there are fewer surprises than in the past. Nevertheless, women are divided in their visions of the perfect birth, and need to be clear with themselves about what is important!

How Am I Approaching My Birth?

Are we taking care of ourselves through the pregnancy — eating right, resting enough, staying active?

Are we working too hard? If you go into labor tired, you will run out of gas and probably bail out prematurely. And if you don’t get some horizontal time during the day as term approaches, you may develop decreased amniotic fluid, inviting intervention. Taking a daily nap will help fluff your amniotic fluid and your energy! Try your best to arrange a place to lie down during your lunch hour, if you must keep working. If you can work short days at the end of your pregnancy, you should.

Is a vaginal delivery important to me? Am I prepared to go through a potential 18 hours of labor — with or without pain relief — to achieve the end result? If the answer is “Yes. Delivering my baby naturally is important to me,” then careful shopping for a caregiver with a proven track record of vaginal delivery is a must.

Do we, as women, shop for caregivers with technical skill and low cesarean section rate in mind — or do we choose based on charm, pretty labor suites and convenient office parking? Sometimes the experienced, cranky, grey-haired male doctor is the one who understands labor really, really well.

Have we been set up to expect failure in labor by being told we have small pelvises? Babies are designed with nice soft heads to fit through tight spaces just for this reason, you know!

Family and self mythology is so, so powerful! “Everyone in my family has cesareans.” Or “I have a low pain threshold.” You’re selling yourself short!

Are we set up to expect our labor on the due date, after which we lose patience? The normal first pregnancy is usually closer to 41 weeks, if we don’t intervene. Induced labors are associated with far more cesareans. If the cervix isn’t nice and soft — and ready — pitocin just won’t work well. Try like mad to avoid inductions, and certainly don’t ask for one!!

Are we so attached to our caregiver that we ask to be induced on his or her day on call? Keep in mind that if you start labor when Dr. Right is on call, you may very well deliver the next day, with Dr. Wrong!

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