How To Avoid a Caesarian or C-Section Birth

C-Sections are epidemic in the United States. 1 out of every 3 women who is pregnant right now will have one. If you need a C-Section to save the life of your baby, it's nothing short of miraculous, and worth every bit of pain and risk.

Sometimes if your baby is breech and can't be turned, or in some cases with twins, a caesarean tremendously lowers the risk to your baby.

If you and your health care adviser have decided that a C-Section is warranted for safety reasons, you'll be scheduling it. Obviously, you'll want to choose a care-giver who's very experienced with C-Sections and a hospital with an excellent record.

But are you aware that C-sections:

1. Are major abdominal surgery with all the attendant pain and possible complications in the following weeks, just when you want to enjoy your new baby?
2. Increase your risk of hemorrhage and infection?
3. Result in a uterine scar and internal adhesions (scarring) that can cause pain and complications for years?
4. Increase your chances of later ectopic pregnancy and difficulty conceiving?
5. Increase your baby's chances of having asthma later in life?
6. Delay your breastmilk coming in, making it so much more difficult to breastfeed that many women give up?
7. Endanger the health of future pregnancies, increasing the chances of low birthweight, premature delivery and stillbirth?
8. Often leave women with medical complaints six months or a year later?

If you really need a C-Section, they are a miraculous life-saver. If you don't, it's best to avoid it.

Luckily, most C-Sections are not actually medically necessary. 85% of all pregnancies are normal and low-risk, and absolutely do not warrant C-Sections. In fact, there is absolutely no medical evidence that a caesarean is necessary just because you had one last time, or because you're over 40. Even with a multiple birth a C-Section is often more dangerous than a vaginal birth.

Most importantly, do you know that you can tremendously reduce your risk of C-section by picking a care-giver who uses certain kinds of birth practices?

VBAC

(Vaginal birth after caesarean) If you had a C-Section last time, you can still have a Vaginal Birth this time. Do you know the most decisive factor in whether a woman can successfully have a VBAC ? Age. But not the age of the mom, or the term of the baby. The age of the doctor!

That's because doctors used to be educated with the misinformation that uterine rupture was more likely with a VBAC. But the New England Journal of Medicine published a landmark study in 2004 showing that uterine rupture occurs in less than 1% of VBACs. In other words, a woman who had a C-Section is just as likely to be able to have a healthy vaginal birth as any other woman.

Are you over 40?

It's true that women over 40 have a 40% chance of having C-Sections, and it is exhausting and demoralizing to struggle through a prolonged labor only to end up in the operating room having a C-Section. BUT did you know that you can hugely increase your chances of being part of the 60% of over-40 year olds who have normal vaginal births? That's right. Most women over 40 do not need a caesarean, and can avoid having one.

Avoiding a C-Section: 
What every pregnant woman needs to know.

You can significantly reduce your chances of having a C-Section by informed choice of a caregiver and birth place. Here's how:

1. Exercise moderately during pregnancy.

Sedentary women are 4x as likely to deliver via caesarean section as women who did aerobics during the first or second trimester.

2. Find a caregiver who has a low C-Section rate

Find a caregiver who has a low C-Section rate and is experienced with successful VBACs. This is true even if you don't need a VBAC, because it means your caregiver doesn't default to caesareans.

3. Find a caregiver who will give you all the time you need

Find a caregiver who will give you all the time you need rather than rushing your delivery because of staffing issues.

4. Ask your caregiver what she does if your baby is in a breech position

Ask your caregiver what she does if your baby is in a breech position in late pregnancy. You want to hear that she is experienced with turning babies and always tries that before scheduling a C-Section.

5. Check Hospital policies.

If you're considering a VBAC, be sure to use a hospital that allows VBACs.

6. Arrange continuous trained labor support

Arrange continuous trained labor support which studies show keeps labor moving. If you aren't using a midwife, supplement your OB by hiring an experienced labor doula. A 2001 study in the journal of perinatal education showed a 56% reduction in the risk of caesarean in women receiving continuous one to one nursing/doula or midwifery care.

7. Be sure that your caregiver and birth venue encourage practices that support the normal process of labor and keep it moving:

• Arrange to stay upright and moving rather than lying down.
• Stay well-nourished and hydrated to give you energy
• Avoid continuous electronic fetal monitoring
• Avoid hastening labor with pitocin, which increases the severity of contractions and makes other medical interventions much more likely.

Using a Mother’s Microbes to Protect Cesarean Babies

The first germs to colonize a newborn delivered vaginally come almost exclusively from its mother. But the first to reach an infant born by cesarean section come mostly from the environment — particularly bacteria from inaccessible or less-scrubbed areas like lamps and walls, and skin cells from everyone else in the delivery room.

Photo

The transfer of the maternal microbiome occurs naturally after (a) a vaginal birth. After a (b) C-section, researchers transferred the neonatal microbiome from the mothers with a (c) gauze treatment.CreditKim Caesar/Nature Publishing Group

That difference, some experts believe, could influence a child’s lifelong health. Now, in the first study of its kind, researchers on Monday confirmed that a mother’s beneficial microbes can be transferred, at least partially, from her vagina to her baby after a C-section.

The small proof-of-principle study suggests a new way to inoculate babies, said Dr. Maria Gloria Dominguez-Bello, an associate professor of medicine at New York University and lead author of the report, published on Monday in Nature Medicine.

“The study is extremely important,” said Dr. Jack Gilbert, a microbial ecologist at Argonne National Laboratory who did not take part in the work. “Just understanding that it’s possible is exciting.”

But it will take further studies following C-section babies for many years to know to what degree, if any, the method protects them from immune and metabolic problems, he said.

Some epidemiological studies have suggested that C-section babies may have an elevated risk for developing immune and metabolic disorders, including Type 1 diabetes, allergies, asthma and obesity.

Scientists have theorized that these children may be missing key bacteria known to play a large role in shaping the immune system from the moment of birth onward. To replace these microbes, some parents have turned to a novel procedure called vaginal microbial transfer.

A mother’s vaginal fluids — loaded with one such essential bacterium, lactobacillus, that helps digest human milk — are collected before surgery and swabbed all over the infant a minute or two after birth.

An infant’s first exposure to microbes may educate the early immune system to recognize friend from foe, Dr. Dominguez-Bello said.

Friendly bacteria, like lactobacilli, are tolerated as being like oneself. Those from hospital ventilation vents or the like may be perceived as enemies and be attacked.

These early microbial interactions may help set up an immune system that recognizes “self” from “non-self” for the rest of a person’s life, Dr. Dominguez-Bello said.

In the United States, about one in three babies are delivered by C-section, a rate that has risen dramatically in recent decades. Some hospitals perform the surgery on nearly seven in ten women delivering babies.

An ideal C-section rate for low-risk births should be no more than 15 percent, according to the World Health Organization.

Dr. Dominguez-Bello’s study involved 18 babies born at the University of Puerto Rico hospital in San Juan, where she recently worked. Seven were born vaginally and 11 by elective C-section. Of the latter, four were swabbed with the mother’s vaginal microbes and seven were not.

Microbes were collected on a folded sterile piece of gauze that was dipped in a saline solution and inserted into each mother’s vagina for one hour before surgery. As the operations began, the gauze was pulled out and placed in a sterile collector.

One to two minutes after the babies were delivered and put under a neonatal lamp, researchers swabbed each infant’s lips, face, chest, arms, legs, back, genitals and anal region with the damp gauze. The procedure took 15 seconds.

Dr. Dominguez-Bello and her colleagues then tracked the composition of microbes by taking more than 1,500 oral, skin and anal samples from the newborns, as well as vaginal samples from the mothers, over the first month after birth.

For the first few days, ambient skin bacteria from the delivery room predominated in the mouths and on the skin of C-section babies who were not swabbed, Dr. Dominguez-Bello said.

But in terms of their bacterial colonies, the infants swabbed with the microbes closely resembled vaginally delivered babies, she found, especially in the first week of life. They were all covered with lactobacilli.

Gut bacteria in both C-section groups, however, were less abundant than that found in the vaginally delivered babies.

Anal samples from the swabbed group, oddly, contained the highest abundance of bacteria usually found in the mouth.

The results show the complexity of labor, said Dr. Alexander Khoruts, a microbial expert and associate professor of medicine at the University of Minnesota. “It cannot be simplified to a neat, effortless passage of the infant through the birth canal,” he said.

As the month progressed, the oral and skin microbes of all infants began to resemble normal adult patterns, Dr. Dominguez-Bello said. But fecal bacteria did not, probably because of breast or formula feeding and the absence of solid foods.

The transfer fell short of full vaginal birth-like colonization for two reasons, Dr. Dominguez-Bello said. Compared to infants who spent time squeezed inside the birth canal, those who were swabbed got less exposure to their mother’s microbes.

And all infants delivered by C-section were exposed to antibiotics, which also may have reduced the number and variety of bacteria colonizing them.

A larger study of vaginal microbial transfer is underway at N.Y.U., Dr. Dominguez-Bello said. Eighty-four mothers have participated so far.

Infants delivered both by C-section and vaginally will be followed for one year to look for differences in the treated and untreated groups and to look for complications. Thus far the swabbing has proved entirely safe.

The procedure is not yet recommended by professional medical societies, said Dr. Sara Brubaker, a specialist in maternal and fetal medicine at N.Y.U. Until more is known, physicians are hesitant to participate.

“But it has hit the lay press,” she said. “Patients come in and ask for it. They are doing it themselves.”

Dr. Brubaker is one of them. When her daughter was born three and a half months ago, she arranged to have her baby swabbed.

Why newborns look so funny

Few newborns look like beauty contest winners, which isn't surprising when you consider what they've been through. But is it really normal for their heads to be so pointy and their genitals so swollen? Here's the top-to-toe scoop on why newborns look so, well, strange.

Head
If you gave birth vaginally, you may take a look at your baby's head and think, "No wonder!" It's big compared to the rest of your baby's body!

Your baby's head may also look a little misshapen or kind of pointy. This is called molding, and it happens as babies squeeze through the birth canal (or when a vacuum extractor is used during delivery). Your baby's head should return to its original shape in a week or two.

C-section babies don't come through the birth canal, so they have an edge in the looks department. Their heads come out nice and round because they don't get squeezed, and their faces don't get swollen like many babies delivered vaginally.

The soft spots on your baby's head, called fontanels, are diamond-shaped openings in the skull covered by a thick layer of skin. These openings – one in front and one in back – allowed the bones of your baby's skull to compress during his trip through the birth canal, and now they allow for the quick growth of his brain.

The rear fontanel takes about six months to close. The front one takes between 12 and 24 months.

Newborns often develop cradle cap – a redness and flakiness on the scalp. It usually goes away in a few weeks or months and is rarely uncomfortable or itchy. If you notice cradle cap on your baby, try washing his hair a little more often with a mild baby shampoo and brushing it with a soft-bristled brush. Don't use medicated shampoos without checking with your baby's doctor because they can irritate tender skin.

Arms and legs
After spending so much time curled up in the tight space of your uterus, your baby needs time to adjust to her new freedom and stretch out a bit. Her arms and legs will uncurl in a week or two. When she does begin to stretch out, she'll probably appear a bit bowlegged until she starts walking.

Some babies find swaddling — being wrapped snugly in a blanket – to be comforting because it mimics the tight quarters of the uterus.

Belly
Your baby might lose a little weight in his first week, but he should regain it during the second week and continue to put on the ounces and pounds at a fast clip in the following months, quickly filling out his belly.

After ten to 21 days, your baby's umbilical cord stump falls off, leaving an adorable little belly button. Occasionally it also leaves a raw spot that may ooze a little blood-tinged fluid. Keep it dry and clean it with a cotton swab dipped in a little rubbing alcohol, and it should heal by itself. If the stump doesn't fall off after a month, talk to your baby's doctor

Genitals and breasts
The genitals and breasts of newborn boys and girls alike often appear swollen. This is caused by the extra dose of hormones just before birth.

A little milky substance may even leak from your baby's nipples. Don't try to squeeze out the liquid – it's harmless and will dry up on its own. Girls may have some white discharge or blood-tinged vaginal mucus.

All of this will go away in the first few weeks.

Skin
Newborn skin varies in appearance according to how far along your baby is at birth. Premature babies have thin, almost transparent skin that may be covered with a fine, downy hair called lanugo. You'll also see vernix, a cheesy, white substance that protects a baby's delicate skin from the amniotic fluid. The farther along your pregnancy is when you deliver, the less lanugo and vernix your baby will have.

Babies of all races and ethnicities are born with reddish-purple skin that changes to pinkish-red in a day or so. The pink tint comes from the red blood vessels that are visible through your baby's still-thin skin. Because your baby's blood circulation is still maturing, his hands and feet may be bluish for a few days. Over the next six months, your baby's skin will develop its permanent color.

If your baby's skin takes on a yellowish tinge in the first few days of life, he may have a slight case of jaundice. More than half of healthy newborns show signs of jaundice, which happens as the body breaks down extra red blood cells.

Jaundice usually goes away in a week or so for full-term babies, but often hangs around slightly longer in preemies. It's usually nothing to worry about, but mention it to your healthcare provider.

Jaundice that doesn't go away may be a sign of a metabolic disorder or a liver problem. Your provider can do a simple blood or skin test to determine whether your baby needs treatment. He may have to spend some time under special lights that help his body get rid of the jaundice.

About 40 percent of babies are born with milia, small white or yellow dots on their face that look like tiny pimples. They usually disappear without treatment in three or four weeks.

If your baby has small, pus-filled bumps that leave dark brown marks when they burst, it's probably pustular melanosis. This newborn rash is more common in African American babies. There's no need to treat this condition. The marks will disappear by the time your baby is 3 or 4 months old.

A hive-like rash made up of red blotches with pale or yellowish bumps in the center is harmless despite its scary-sounding name. Called erythema toxicum, it usually appears a day or two after birth and is gone within a week.

Acne isn't unusual in new babies, either. About a fifth of newborns have a case of acne during their first month, the result of maternal hormones that circulate in the baby's body after birth.

Newborn acne is most likely to show up on the forehead and cheeks. It can worsen if your baby lies on sheets that have been washed in harsh detergents or soiled with spit-up. Place a soft, clean receiving blanket under his head while he's awake, and wash his face gently once a day with a mild baby soap to remove detergent or milk residue.

Otherwise, normal baby acne should disappear on its own within a few months once excess hormones dissipate.

Birthmarks like Mongolian spots (flat patches that look like ink stains) and salmon patches (sometimes called angel kisses and stork bites) are also common. They come in a wide range of shapes, sizes, and colors and can show up anywhere on a baby's body. Certain types of birthmarks may not appear for several days or weeks after birth.

Most birthmarks are harmless. Many go away on their own in the first few years of life, although some, such as flat, reddish-purple marks called port-wine stains, are permanent.

Hair
Be prepared for some surprises when it comes to your baby's hair. Dark-haired Caucasian couples have been thrown for a loop by children born with bright red or blond hair, and fair-haired couples have been presented with Elvis Presley look-alikes. And then there are the parents who wonder what color that peach fuzz is, exactly.

That said, newborn hair doesn't tend to have much bearing on what your child's hair will eventually look like. Even if your baby was born with a full head of hair, she may begin to lose some or all of it in the first few weeks or months. This often happens because babies spend so much time on their back.

Don't worry – the hair will come back, although it may not look the same when it does. Babies born redheads can turn into blonds, raven-haired newborns can sprout fair tresses, and blonds often turn into brunettes.

Hair texture frequently changes in the first six months, too. You may find coarser, tighter ringlets growing in place of your baby's loose, fine curls, for example.

Eyes
Most, though certainly not all, Caucasian babies are born with dark gray-blue eyes that can take months or years to reveal their permanent color. Many African American, Asian, and Hispanic babies are born with dark gray-brown eyes that don't change color significantly, but some may start out with hazel eyes that get darker as they approach 6 months.

Most often, the eye color you see at 6 to 9 months is the one that sticks around.

Sometimes newborns have red spots in the whites of their eyes. Though it may look alarming, it's a harmless side effect of the trauma of birth. It's called a subconjunctival hemorrhage and should go away within several days.

Ears
Your baby's ears may be soft and floppy, and one of the edges may be bent over a bit. As the cartilage in your baby's ears becomes harder, her ears will become more defined.

Nose
Your baby's nose may look swollen from the pressure on it during delivery. It may also be a little flattened or even off-kilter. (He'll look less like a prizefighter in just a few days.) Your baby's appearance and behavior will change quite a bit in his first year of life. For information about your baby's physical and emotional milestones,