Giving Birth with Confidence, Safe & Healthy Birth
Cesarean Awareness Month - How to Avoid Unnecessary Surgery
Cara Terreri
April is Cesarean Awareness Month (CAM) around the world. For some global locations, there are too few cesareans performed and pregnant/postpartum people and/or their newborns are dying or experiencing complications. (In the sub-Saharan region of Africa the rate of cesarean section is 4%.) In other locations, including in the United States, there are too many cesareans performed and pregnant/postpartum people are dying or suffering from significant complications. (Some Latin American countries have a cesarean rate around 60%, the USA’s cesarean rate is just shy of 32%.) It is estimated that about six million unnecessary cesareans are done each year, half of them in Brazil and China (Boerma, T., et al, 2018.) It is believed that approximately 60% of cesareans are not clinically necessary. Research has indicated that 25 percent of countries underuse cesarean sections, while 60 percent of countries were found to overuse the procedure (Wiklund, I., 2018.)
Due to the continued lack of access for a trial of labor after cesarean (TOLAC), people who birth after a surgical birth often have a planned repeat cesarean. This makes it even more critical to prevent the primary cesarean. Risk of death and complications, especially for the birthing parent, increase with every cesarean that a person undergoes.
Many pregnant people don't want to think about the possibility of having a cesarean, planned or unplanned. “I didn’t even read that section of the book, because I didn’t want to think about that,” is a common statement that I often hear from students. The likelihood that a person will give birth by cesarean is real. If you are pregnant, it's important to take steps to reduce your chances of birthing by cesarean. A quality childbirth class that covers informed choice, helps you identify an evidence-based provider, and provides in-depth information on interventions can help. In order to help reduce your chance of cesarean as well as prepare for the possibility of birth by cesarean, look for a childbirth class with the following objectives:
- Identifying an appropriate provider and birth facility based on your health status and birth intentions/preferences.
- Facilitating confidence in your own ability to navigate informed consent and decision-making conversations with care providers
- Information and encouragement for adding a birth doula to your team to offer support, information, and assistance with coping and comfort measures.
- Preparation for the possibility of a surgical birth; how to make it positive and information on evidence-based actions in the operating room.
- Resources on cesarean and VBAC, including support groups, in the event you give birth by cesarean in order to receive continued peer-to-peer support and information.
While April is Cesarean Awareness Month, the topic should be reviewed no matter when you or someone you know is pregnant. Thorough understanding and preparation helps reduce your risk of giving birth by cesarean when there is not a medical need, as well as have the best experience and ongoing support possible should a cesarean become necessary.
References
Boerma, T, Ronsmans, C, Melesse, DY, Barros, AJD, Barros, FC, Juan, L, et al.. Global epidemiology of use of and disparities in caesarean sections. Lancet 2018;392:1341–48. https://doi.org/10.1016/s0140-6736(18)31928-7.
Wiklund, I, Malata, AM, Cheung, NF, Cadee, F. Appropriate use of caesarean section globally requires a different approach. Lancet 2018;392:1288–89. https://doi.org/10.1016/s0140-6736(18)32325-0
About Sharon Muza