This month’s Brilliant Activities for Birth Educators activity is aligned with Cesarean Awareness Month, which is observed annually in April.  It is short and to the point, and helps families identify the cesarean rates of their chosen birth location.  With this information, families can have conversations with their health care providers about how to avoid a cesarean that is not medically necessary.  To find all the Brilliant Activities for Birth Educators activities for free, follow this link.

Introduction

April is Cesarean Awareness Month, and it is a fact that some of the families in your childbirth classes will give birth by Cesarean.  This is not always a bad thing.  Cesareans can save the life of a baby or a parent and there are many circumstances when a cesarean birth is absolutely indicated.  But, it is estimated that cesareans are “unnecessary” approximately 50-60 percent of the time, and often performed when not indicated.  In this type of situation, there are increased risks, both short and long-term for both the birthing person and the newborn, that were assumed unnecessarily.  Families may not be aware of what the cesarean rate is for their chosen birth location, and therefore were not able to use that information to make an informed decision on where to give birth.  One of the best predictors of the outcome of someone’s birth is where they have chosen to give birth.  This activity helps families to do their own research and locate the cesarean rates of hospitals in their area.  It also allows the childbirth educator to share information that can help them avoid an unnecessary cesarean.

Materials

Links to cesarean rates of hospitals in your area - some possible places to start include:

• Leapfrog
• CesareanRates.com
• Centers for Disease Control and Prevention
• Consumer Reports
• Your state or provincial government’s department of health website.

Recommendations for appropriate care

• ACOG’s Safe Prevention of the Primary Cesarean
• ACOG’s Approaches to Limit Interventions during Labor and Birth

When to conduct this activity

I see two opportunities where this activity may be appropriate.  The educator may consider using this activity early on, when families are getting familiar with the content and what is a safe and healthy birth. Introducing this topic soon in a class or class series will get the discussion going.  Another alternative is to cover this activity when discussing birth planning and/or cesarean birth.

How long to allow for this activity

Planning for 10 to 15 minutes, with a possible homework assignment of researching specific cesarean rates after the discussion would work well.

How to conduct this activity

The educator can introduce the topic of current best practices and what makes for a safe and healthy birth.  Sharing that the place of birth and choice of provider plays a key role in how a labor and birth unfold and ultimately the mode of delivery.  Inviting class members to share how they chose their provider and birth location with others is helpful.  Facilitate a discussion about people who may have changed locations and providers during the course of their pregnancy and the factors that went into that decision.  Inquire if people know the cesarean rate for their birth location.  Take a moment to introduce the difference between NTSV, primary and overall cesarean rates so families understand the differences and subtleties.  Invite families to discover the cesarean rates for their birth location.  Provide your favorite resources on evidence based care that they might want to use when discussing their need for a cesarean with their health care provider at an upcoming appointment.  

What families have to say about this activity

Families have enjoyed the discussions on this topic and have been curious to explore the data on their facility of choice.  They state they have a clearer understanding of the importance of asking for evidence based care.

Conclusion

One of the reasons that I love teaching independent childbirth classes is having a mix of families birthing in many locations across my metro area who gather all in one place.  This activity helps families learn more about the choices they have made and what potential options are available to them.  Repeatedly, families tell me that they made a decision on birth location based on “the hospital was practically in my backyard” or “I was born there 30 years ago” or that is where the provider who has been their gynecologist practices.  They consider their choice with fresh eyes as they learn about best practice and how to ask for quality care.  They have said that this activity helps them have important conversations.  The purpose of this activity is not for people to make a change, but rather to initiate a conversation with their provider about how to avoid an unnecessary cesarean and explore all the options available to them.  If families do not have accurate information, they can not evaluate if they are doing everything they can to avoid unnecessary interventions that may result in an unneeded surgical birth.

Would you consider conducting this activity in your classes?  How do you help families evaluate if they are receiving good care and are supported by their birth team in having the type of birth they want?  Let us know in the comments below.

References

ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol. 2019 Feb;133(2):e164-e173. doi: 10.1097/AOG.0000000000003074. PMID: 30575638.

Caughey, A. B., Cahill, A. G., Guise, J. M., Rouse, D. J., & American College of Obstetricians and Gynecologists. (2014). Safe prevention of the primary cesarean delivery. American journal of obstetrics and gynecology, 210(3), 179-193.

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