Thinking about my sister today, any tips to avoid a c-section?

[bisous]

There isn't any reason she is indicated for a c-section right now, except that I just had my 3rd and my Mom had 4. It "runs in the family" if you will. My first c was "failure to progress" but really I progressed to pushing and then couldn't get DS1 out! The subsequent cs were scheduled really as a result of my first (DS2 was breech, too).

This is what I'm telling her:

Don't induce--wait until your labor starts naturally, the baby will then be "ready"

Don't labor on your back. Laboring in that position makes it that much harder if you are already narrow down there.

Go natural? This is the hardest part for me. After having had 3 sections, I absolutely wish I had gone natural with DS1. But at that time without all the hindsight available to me, you couldn't have paid me a million dollars to do it! I'm hoping she'll at least do some research. It seems like everyone around us is all about epidurals!

Anything else?

[mikala]

Your list is great. It also helps to have a provider that doesn't push convenience c-sections or inductions.

A doula can also help with emotional and physical support during labor.

If she can avoid the epidural she will have more ability to push in different positions.

It may also help to stay active in pregnancy. Walking, swimming, prenatal yoga, etc. We wouldn't run a marathon without training a little and all of those things should help with pregnancy aches and couldn't hurt for labor.

None of these are guarantees but all should stack the deck a bit in favor of a vaginal birth.

[daisymommy]

Avoid the "cascade of interventions" as it is called (some of which you have pointed out already).

Having your water broken by the doctor puts you on the clock, and many docs will say if the baby is not born in 12 hours, then they will force a c-section. The longest you can go without infection setting in is 24 hours, and that is what my midwives allow, but most OBs will not. They will often break your water to try to hurry things along though or get you started out in labor in they find you to be 2 or 3 cm. but your contractions are close enough together, or hard enough. That just means you need to stay home and let your body keep working longer! Water wasn't meant to break before mid-late labor. It's there to cushion the baby, and soften the pain of contractions.
I wouldn't allow this unless you were maybe 6 cm. When this doesn't work quick enough, they want you to have pitocin...

Avoid pitocin if at all possible! Don't give in to the "you're not progressing fast enough, hard enough labor" etc. Once you get pit, the contractions usually come fast and hard, and very painful. Which sets you up for...

An epidural. Which means no walking around and being able to allow gravity to work. Which sets you up for...

Laboring and pushing flat on your back, and keeps things narrow inside. Which sets you up for having a hard time pushing baby out. Which sets you up for...

You guessed it, a c-section.

*Huge disclaimer! I know we don't always have control over things. I know many women have one or more of these things in their labor and still are able to deliver vaginally just fine. BUT it does pre-dispose you to leaning towards having a c-section. With each intervention you add, you are more likely to wind up with a c-section. So I would avoid any of these interventions if at all possible.

[mmommy]

I'm trying for a vbac with my second pregnancy, and a few things I'm doing this time are helping me feel more empowered/prepared:
*Hiring a doula
*Reading a few key books: Birthing from Within & Ina May's Guide to Childbirth are both great
*Prepare to labor at home as long as possible
*Work with an OB/midwife with a good vbac track record and who speak encouragingly about my ability to have a vbac every time I see them. (I think this is something I'd suggest even for a first time mom, an OB or midwife who does vbac. it suggests to me a willingness to work outside of the usual hospital labor window)
*Believe in myself, my body, and my caregivers/birth team

Now, I don't regret my c-birth as it truly was necessary, but for reasons that don't make subsequent births necessarily scheduled-c's, so I'd also add that if there is no other way, a c isn't the end of the world.

[mikala]

Water wasn't meant to break before mid-late labor. It's there to cushion the baby, and soften the pain of contractions.
I wouldn't allow this unless you were maybe 6 cm.

Daisymommy had some great suggestions. This one caught my eye because for many moms I know the waters broke naturally before contractions began. If this does happen you can reduce the risk of infections and potentially buy time by not having internal exams unless absolutely necessary. A midwife I know phrased it as "only out, not in."

I just found this site with a quick Google search and don't know the accuracy but it matches a lot of what I've read and heard from midwives.

http://doulamomma.wordpress.com/2009/07/22/when-your-water-breaks-before-labor-begins/

[SnuggleBuggles]

Good lists. Now, start stacking the deck with what books you choose to give her. Instead of some fluff or mainstream fare, get her Dr. Sears and Penny Simkin. Simkin's "Pregnancy, Childbirth and the Newborn" is a great, all purpose pregnancy book that won't come across as uber crunchy. I was not totally firm on anything about birth with ds1 till my friend gave me books like those. I had only read mainstream stuff and wasn't exposed to alternative ideas IRL. They opened my eyes and utterly transformed my feelings about birth; went from being scared to excited. So, get her good books. :)

[SnuggleBuggles]

Daisymommy had some great suggestions. This one caught my eye because for many moms I know the waters broke naturally before contractions began. If this does happen you can reduce the risk of infections and potentially buy time by not having internal exams unless absolutely necessary. A midwife I know phrased it as "only out, not in."

I just found this site with a quick Google search and don't know the accuracy but it matches a lot of what I've read and heard from midwives.

http://doulamomma.wordpress.com/2009/07/22/when-your-water-breaks-before-labor-begins/

Only 8- 10% of the time. :) It did happen to me with ds1 and he was posterior. What I wouldn't have given to have understood what that meant ahead of time! I must have skimmed over that complication in all my research. If I had known about it, I would have talked to my care providers in the last weeks of pregnancy about whether my baby was posterior and what I could do to rotate the baby before labor. Malpositioned babies are so, so overlooked!

[bisous]

Thanks, all. Really helpful. I'm trying to meet my sister where she is. I think she is very likely where *I* was when I had my first. I'll check out those book recs. Not too crunchy is important.

It is so important I feel because while all FOUR of my SILs regularly get induced for their babes and nobody has ever had an issue, I just KNOW that with our genetic issues, we need to be extra careful. How I wish I had never had a c-section! Nothing wrong with it as a way to bring a baby into the world, but much more complicated. If she's going to get one, I want it to be because of medical need and not poor management, KWIM?

[daisymommy]

It's so hard when family members are on a different page as you are, but you only want the best for them. Such a fine balance of what and how much to say. And many times they only "get it" through hard experience and hindsight. Hopefully she will listen to you and do some reading!


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[123LuckyMom]

Also, labor at home for as long as possible! The sooner you go into the hospital, the more likely you are to have interventions or to have interventions you wanted administered too early so that they stall labor and lead to more interventions. Stay home as long as you can!!!

[Jenn850]

Maybe get her a copy of The Business of Being Born if she is not too "crunchy"? Then she can come to it on her own with little reading? But if you really do have a genetic predisposition, also be gentle. I was desperate to have a vbac with ds, and when it didn't work out for me I felt really sick about it for a long time. Kind of still do...

[SnuggleBuggles]

Thanks, all. Really helpful. I'm trying to meet my sister where she is. I think she is very likely where *I* was when I had my first. I'll check out those book recs. Not too crunchy is important.

It is so important I feel because while all FOUR of my SILs regularly get induced for their babes and nobody has ever had an issue, I just KNOW that with our genetic issues, we need to be extra careful. How I wish I had never had a c-section! Nothing wrong with it as a way to bring a baby into the world, but much more complicated. If she's going to get one, I want it to be because of medical need and not poor management, KWIM?

Probably pick the Simkin book instead of Sears then. :)