April is Cesarean Awareness Month and today's Brilliant Activities for Birth Educators post closes out the month with an activity designed to help families distinguish between "hard" and "soft" reasons for a cesarean birth. Childbirth educators prepare families for a variety of situations through education and understanding why and when a cesarean is indicated is part of the process. You can find and follow along with the entire Brilliant Activities for Birth Educators series by clicking here.

Introduction

The current cesarean rate in the USA is just under 32% and seems to be slowly, slowly creeping down. Canada's rate is still going up and while the NTSV rate is lower, it is a fact that if there are to be any major changes on the number of cesarean births, it is key to prevent the primary cesarean from happening.

Teaching the standard roomful of families expecting their first baby, one can expect that several of them will end up giving birth by cesarean. There are times when a cesarean is an appropriate and necessary alternative to a vaginal birth, but it is estimated that half of all cesareans are unnecessary. Helping families to understand when a cesarean is absolutely necessary and when there may be other options is a key part of the birth education process. Letting families discover that some situations may warrant further discussion with a healthcare provider to explore alternatives may be helpful and achieve a vaginal birth.

Materials

• Laminated cards, each with a reason for a cesarean birth
• Another two laminated cards, one saying "Hard" and one "Soft"

You can do this as an entire class by having these cards on 8 1/2 by 11 paper, or use smaller sets and let the class work in small groups.

When to do this activity

In my seven week series, I do this week four or five, when we talk about cesareans and other variations of labor. Regardless of your class type, this could introduce or close out the topic of cesarean birth. I also teach a one day VBAC YOUR Way class and do this quick exercise in that 8-hour class as well.

How to do this activity

I prefer to do this activity in small groups and then process it as an entire class. I start off by asking the entire class if they know anyone who has given birth by cesarean and if they know why a cesarean was performed. They popcorn the reasons that they have heard or know of. I then introduce the topic of necessary cesareans and situations when there might have been a different option. The class forms into small groups of two or three families each and are given one pack of the above cards. I ask them to work together to sort all the reasons for a cesarean into two groups, one pile for reasons that have no other options and another group that might be able to achieve a vaginal birth with a supportive and skilled team.

When it appears that the small groups have all completed the sorting activity, we come back together as a large group to discuss and clarify answers. There is an opportunity to brainstorm alternatives that might prevent a cesarean when one is not absolutely necessary.

The takeaway and what families share about the activity

Families are surprised to learn that most of the reasons that someone might have a cesarean are soft reasons and that there might have been alternatives that would have resulted in a vaginal birth in other circumstances. Knowing that there are questions to ask and things that families can do to set themselves up for success builds confidence and reinforces the importance of shared decision making. Doing t his activity in class can also help families to dialogue with their providers and ask questions in advance of labor.

The families always remark that they leave this exercise with new information that they did not know before. Many share that they are going to have further discussion with their doctor or midwife. There is a consensus amongst the class that people do not know that they have more choices than they think they do. There is a lot of discussion about how hard it is to find out a facility and a provider's cesarean rate. The activity is appreciated and while quick and easy, has a lot of impact for participants.

Conclusion

While April is Cesarean Awareness Month, understanding the reasons for a cesarean is an important part of a childbirth education class all year long. This quick but effective activity helps families understand what circumstances leave no wiggle room for a vaginal birth and what conditions are opportunities for discussion and further information gathering. Do you think that you would try this activity in class? Would you add any hard or soft reasons to the list that I have included? Let me know in the comments section below.

Resources

Jolles, D. R. (2017). Unwarranted Variation in Utilization of Cesarean Birth Among Low-Risk Childbearing Women. Journal of Midwifery & Women's Health, 62(1), 49-57.

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