April is Cesarean Awareness Month and it is appropriate for this month’s Brilliant Activities for Birth Educators activity to be on the topic of cesareans and vaginal births after cesarean (VBACs) with a fun and simple idea that can be used both virtually and in person. For free access to all the Brilliant Activities for Birth Educators ideas, please follow this link.

Introduction

The current cesarean rate in the United States is hovering around 32% and this number has been fairly flat for the past years. Physician and midwifery professional organizations in the United States, Canada and beyond are in agreement that the current cesarean rate in many places is too high and can cause more harm than good, with a prolonged and more complicated recovery post surgery and additional impact for future fertility, pregnancies and births. Sharing some simple facts about cesarean birth and VBAC in an informal activity is appropriate for childbirth classes, so that expectant families can understand facts and how to advocate for appropriate and evidence based care.

Materials

There are not many materials needed for this activity. Preparing a slide deck to display either in class or on a virtual meeting platform is really all that is needed, and if the educator wanted to take it up a notch, using a quiz/question platform like Kahoot, PollEverywhere, Menti or even Google Forms would be a great option.

A set of 5-10 sets of questions about the topic of cesarean and VBAC, with two being true/accurate and one being false for each set. 

Here are five sample sets of questions for you to use, but you can and should edit the content or change the number as needed for your audience. Remember to vary the order so that the false statement is not always in the same position. Consider having further information on the statements to clarify any questions.

T: Calf compression sleeves post surgical birth help prevent blood clots, a common surgery complication.

T: Hemorrhage, infection and damage to nearby organs are the three most common complications of a cesarean birth. 

L: “Once a cesarean, always a cesarean” is still true and best practice.

T: Labor dystocia (“failure to progress”) is the most common reason a cesarean is performed in the USA.

T: Clear drapes (windows) can be requested so that the birthing parent can watch their baby be born via cesarean if desired.

L: After the baby is delivered through the incision, the placenta is delivered vaginally.

T: The postpartum stay after a cesarean birth is typically an additional 24-48 hours longer than for an uncomplicated vaginal delivery.

T: A person who has a cesarean birth will have lifting and activity restrictions to prevent injury and support the recovery stage.

L: The term cesarean comes from the fact that Julius Caesar was the first person born this way.

T: It is possible to do skin to skin in the operating room after a cesarean birth and in some cases the baby may even initiate a breast/chestfeeding session if everyone is stable.

T: A typical cesarean birth takes around 30 minutes.

L: During a cesarean, the rectus abdominis muscles are cut so the obstetrician can access the uterus and remove the baby.

T: The suggested delivery to delivery interval for a VBAC is 18 months.

T: The uterine rupture rate after one low transverse incision cesarean birth is approximately 0.5%

L: ACOG states that VBACs for twin pregnancies are not appropriate.

How much time to allow

This activity is relatively quick to conduct and can be done in about 10 minutes. It is possible to allow for more time for discussion and further questions from the class.

When to conduct this activity

This engaging activity can be done as an ice-breaker at the beginning of the class where you will be talking about cesareans, it can be done as a review after the topic has been discussed or you can actually use it as part of the learning activities for this topic.

How to conduct this activity 

Introduce the topic and let the class know that there are some myths and facts surrounding cesareans and VBACs and you are going to ask them to identify which statements are not true. Put up one set of three questions, invite them to read and select individually which statement is not true. When everyone has had a chance to complete the question set, ask them to identify which is the false statement. Provide further explanation and details and answer any questions the group might have on that triad of statements before moving on to the next set. Alternately, each family can go through the entire set of questions individually, or you can break up the class into smaller groups before coming back together to go over the subject matter.

If you have a particularly interested group, consider inviting them to write a set of statements and present to the rest of the group to test their knowledge.

What families appreciate about this activity

There are many inaccuracies and half truths surrounding cesareans and people often make decisions based on false or incorrect beliefs as they prepare to welcome their baby. Understanding the benefits and risks of cesareans and VBACs is an important part of the decision making process for families during birth. With approximately one third of all births being surgical ones, it is necessary for families to be able to ask questions and explore options before providing consent for a cesarean delivery. Families are often surprised at the misinformation they have around the topic and appreciate the opportunity to receive accurate information in a safe and informative activity in their birth class.

Conclusion

It is estimated that approximately 60 percent of all cesarean births in the United States could have been prevented. Avoiding the first cesarean is imperative to preventing subsequent births from also being cesarean births. Helping families to understand when a cesarean is appropriate and how they can avoid giving birth by cesarean when a vaginal birth would have been preferred and possible is very much a key part of a comprehensive childbirth class. This “Two Truths & a Lie - Cesarean Style” is a simple and effective way to cover this material.

More on this topic

If you want more ideas for teaching about cesareans and VBACs, consider these Brilliant Activities for Birth Educators posts:

• Cesarean Section Role Play Helps Prepare Families
• Cesarean Birth Preferences
• Virtual Backgrounds to Teach about Cesareans (or Really Anything)

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