So what WOULD lower the chances of a FTP C-section?

[bisous]

First I wanted to reiterate that I had a FTP C-section that I'm actually pretty okay about. I REALLY don't want to offend anyone reading this thread or partcipating in this thread and to be honest I think I've asked a similar question before. I just thought this might be the opportunity to put down a list of factors that contribute to the high FTP C-section rate in the name of presenting more information to all moms.

Reading all the current posts about c-sections and VBACs made me curious about what exactly we know about preventing C-sections? I know in my case DS just wasn't in a good position to come out (he was slightly angled in the birth canal) but I'm not exactly sure what caused this.

So...what do we KNOW about preventing these kinds of cases? What kinds of studies are out there?

And second, what are your gut feelings or your anecdotal experiences or wisdom that came from an experienced OB, midwife or doula?

I can't produce any scientific studies but my feeling is that a major factor in my own FTP C-section was my very strong epidural that kept me laboring in bed on my back. I think that if I could have labored in different positions that might have made the difference for me.

Your thoughts?

[Momof3Labs]

I came very close to a "too big baby" c-section with DS1 (he was a high-forceps delivery), but I feel that positioning was at the root of our problem. He was posterior. I was kept flat on my back in bed by the nurses from the time I showed up at the hospital (1cm, membranes ruptured and GBS+). Got an epidural after a slow progression to 3cm, and stalled a few times after that but did finally hit 10cm. Note that the OB who delivered DS1 never commented on or cared about his position, as long as he wasn't breech, of course.

My second was delivered by an experienced, capable CNM, who noted a couple of weeks before his birth that DS2 was prone to flipping posterior when I laid on my back for exams. She encouraged me to sit upright or lean forward, spend time on my hands and knees on the floor, and lay only on my side (do not sit/lay in a reclined position). I truly believe that it made a difference, and when it came time to push DS2 out, he was positioned properly and came out with little fuss (despite being bigger than his brother).

www.spinningbabies.com is a great site about positioning. I don't think that it can fix everything, but I do think that it made a difference for me.

[brittone2]

For fetal positioning, IMO things that can help are working on positioning well before labor (like the spinningbabies site Lori linked to). Not slouching, not reclining, etc. a lot during pregnancy is all part of that. It isn't a guarantee, but it can help, and certainly won't hurt.

Avoiding an epidural allows you the flexibility to try different positions during labor. Trying things like all 4s, sitting on a birthing ball, etc. can help some babies descend or change their position to a more optimal one. If you have a hospital that doesn't encourage active labor through their policy and procedures (like EFM, which for a normal pregnancy/labor has not been shown to improve outcomes, but does increase the risk of c/s and is there to reduce physician liability), it makes it more difficult to try different positions that may encourage the baby to rotate.

Having a doula has been shown to statistically reduce the rate of c/s.

Staying out of the hospital until you are well into active labor (in a normal, healthy pregnancy and labor) has been shown to statistically reduce the odds of c/s. Once you are there, they are hesitant to discharge you for liability reasons, and you go on the clock. So in those cases, they may start pit, etc. when it may not truly be medically necessary. Some physicians still think women should adhere to dilating a cm. per hour or other "milestones" that aren't really medically necessary assuming the baby and mom aren't showing signs of distress.

None of those things guarantee that a mom and baby won't experience FTP of course. But, for someone interested in stacking the odds in their favor, they can help in many cases. Those things don't guarantee that a mom and baby won't need or experience a c/s, but they are things to consider trying IMO.

ETA: I also think it is important to consider that a lot of obstetric procedures are done because that's the way they've "always been done" and the way many physicians were taught. Those procedures are not always very well grounded scientifically. ACOG's own report found the following:

"Conclusion: Only 29% of the American College of Obstetricians and Gynecologists recommendations are level A, based on good and consistent scientific evidence."

http://pt.wkhealth.com/pt/re/ajog/abstract.00000447-200606000-00010.htm;jsessionid=HHfKKNjnYRhhz99WxN11bGCrdYJ9N hGNTdhpBZ9j9L3PxH1hl1kG!-1297386286!181195629!8091!-1

many policies and procedures are steeped in tradition, but not necessarily scientific evidence. In the current climate, many of those procedures and policies are in place to minimize liability, but do not necessarily improve the outcome for mom or baby.

Again, I'm not bashing all OB/GYNs. I just think that continuing to push policies and procedures on women that are not well-founded from a scientific basis is one of many reasons for the current c/s rate, combined w/ concerns over physician liability. That doesn't mean there aren't c/s that are needed, but those are IMO factors that contribute to the alarmingly high rate.

[o_mom]

For me, I was really close to a c-section with DS1. I pushed for 8 hours with little progress and they were going to try the vacuum when he finally turned enough to come out. He had a huge hematoma on his head (the size of a golf ball) from where he was stuck.

My next two practically flew out (< 2 and 4 hr labor w/< 10 min of pushing) and they were bigger, so I know it wasn't that he was 'too big'. Positioning was a huge factor. I had really bad back pain the last few weeks which got to the point where I was literally laying in a recliner all day with a cooler of food and drinks and crawling to the bathroom. DH had very little vacation and sick time so we were saving it for the birth. This was about the worst position to be in for the weeks leading up to labor.

My labor was spontaneous, but we rushed into the hospital way too early. Dh was pretty useless as a labor partner (love him dearly, but being a doula is not in his future). After 9 hours of excrutiating contractions I got the epidural. I was confined to bed, though I did move quite a bit in bed. I never felt the urge to push and was basically completely numb to the point I couldn't move my legs. After 24 hrs I was exhausted and ineffective and as they were prepping for vacuum he finally moved. I had a really hard time w/bf him and couldn't walk for 12-14 hrs after.

With DS2 & DS3 I made a point of working on positioning with pelvic rocks and such. It was a huge difference as they were much shorter.

For the first time mom, I would say to focus on positioning as the first step - see spiningbabies website above. If you do get an epidural - make a point of moving around, even just in bed. Get on hands and knees, squat, sit up straight on the edge of the bed, etc.

Second would be to avoid induction - do not induce just because you feel 'done', do not induce because your doctor is going on vacation or a holiday is coming, etc. Induction doubles (or more) your risk of c-section for a first time mom. With rates over 30%, that is a huge factor.

Third would be to stay home as long as possible. Really, to the point of almost feeling like pushing would be the best thing. Once you are in the hospital, you are on the clock and they are likely to push interventions and remind you of how little you are progressing.

I don't have any of the research at hand - most is antecdotal anyway. I know the induction c/s link has been shown in several good studies.

[kochh2]

I've totally btdt, this will be short, as i have a tired, cranky baby, but I did have FTP C-S that my CNM finally called after over 20 hours of active labor with *Yeeeouch* pit and not epidural till the very end. AND extensive cervical massage to help with dilation... none worked, i needed to put aside my heroicism and have my baby! the second time around, the same CNM, i did the spinning babies stuff, I did all the things mentioned here, as well as weekly chiro adjustments and acupuncture and homeopathy and we were all commited to a VBAC, down to staying at work all day in active labor (5 min apart!!) and still... ftp!! i made a decision the second time around to c/s because i'd labored for 24 plus hours, made no progress, and the risk of uterine rupture was not a risk i was willing to push... my family was more important than my pride! baby #1 was a big guy, probably not descended perfectly straight... baby 2 was teeny, in perfect position... who knows... My midwife, who i think very highly of all around said that some women really just can not give birth vaginally... had it been hundreds of years ago, i'd have died in childbirth possibly... but it's 2008, and i am thankful for the chance to be a mommy because of my midwife and the doctor who helped my give birth to my babies.
i will continue to commit myself to VBAC in these very same ways until our family is complete!!

[psophia17]

Good question. I did everything I could think of to get DS2 into position, and that's where he was while I laboured, too. Only he never got past whatever scar tissue I had from my first c/s. He failed to progress, my labour did not...