It’s important to understand where your caregiver, birth facility and insurance company stand on cesareans before you commit.

By Carol Ward, M.D. via our friends at Mindful Mama.

In order to determine why the cesarean section rate has skyrocketed in the last 50 years, let’s begin by asking the health care system some questions.

Let’s ask our caregivers some questions:

“Why might I end up with a cesarean section?”

Years ago, breech babies were delivered from below, but they account for only about 5 percent of the increased rate. “Instrumental” deliveries (forceps) may have accounted for another 5 percent. Low amniotic fluid at term, which is normal and was never detected before ultrasound, can decrease the cushion around the cord, and can be a reason for fetal distress in labor. Twins have a higher rate as well, but far and away the most common reasons for cesarean are failure to progress, cephalopelvic disproportion or obstructed labor. These overlapping terms basically all suggest that the baby is too large for the mother’s pelvis, or the power that the uterus is generating is not enough to mould the head through the pelvis. In many cases, a longer trial of labor, stronger contractions, better maternal positioning during pushing — or simply patience might have produced a different outcome.

“What is your (or your group’s) cesarean rate?”

This is a loaded question, and can evoke a guarded or complicated response for both midwives and doctors. If your doctor has a 10 percent rate, but the group consists of eight doctors and the group rate is 40 percent — you may end up delivering with any of the other seven doctors — your chances of a vaginal delivery are about 50 percent. If the group has midwives, your doctor’s rate may be higher because he or she counts the c-sections done for midwives, but not the normal deliveries they attend.

“What is your induction rate?”

If natural labor is more functional labor, will your caregiver follow an overdue pregnancy or slightly low amniotic fluid with testing, and not jump right into induction?

“Do you ever use forceps?”

Sadly, the use of forceps is dying. Skillful use of forceps has saved countless lives — both maternal and neonatal — over the past 200 years. Babies who could have been safely delivered this way are now either delivered by vacuum extraction or cesarean.

“Do you encourage your patients to ambulate in labor?”

There is ample evidence that walking helps shake your baby into the right position for normal delivery.

“Do you use intermittent fetal monitoring, or keep patients on the monitor continuously?”

As long as your labor is normal and the baby shows no signs of distress, there is no reason you need to be nailed down to the bed.

“Do you try to turn breech babies?”

The answer should always be “yes.”

Let’s ask hospitals a few questions:

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