Avoiding a C-Section

by Rita Rubin

If you're African-American, at least 40 years old or less than 5-foot-1, research suggests that you have a higher chance of delivering by C-section than a woman who's Caucasian, under age 40 or 5-foot-1 or taller -- all other things being equal. Now, of course, you have no control over your race, your age or your height. But if you've weighed the pros and cons and decided you'd prefer to deliver vaginally -- and you have no pressing medical reasons not to -- there are steps you can take to minimize your chances of having an unplanned C-section.

This may seem pretty obvious, but it bears repeating: If you want to avoid a C-section, look for a hospital and a doctor with low C-section rates, preferably 15% or less for first-time moms delivering full-term, head-down babies. (Remember that hospitals and doctors with a preponderance of high-risk patients may have higher C-section rates. Their higher rates don't necessarily reflect the average patient's experience.)

While hospitals are supposed to provide you with their C-section rates, you might have some trouble obtaining accurate information about the rates for individual physicians. Probably the best thing to do is call around and talk to labor and delivery nurses. Of all people, they'll know which doctors have high C-section rates. Local childbirth educators and doulas (specially trained women who provide childbirth support) can also be valuable resources for this information.

"You have to find a doctor who is really willing to work with you to avoid a cesarean," says Lani, 32. "To a lot of doctors, I found, it's not important. They're there, they feel, just to protect your life."

In other words, Lani says, these doctors jump more readily to the conclusion that a C-section is necessary to save the mother or the baby. They don't understand why women would care about the delivery process as long as it resulted in a healthy baby.

Lani practically took the words right out of the mouths of a research team from the University of Bristol in England, which recently published a small study of women who had either had an unplanned C-section or a vaginal delivery involving forceps or vacuum extraction. "The priority for the obstetrician is safe delivery for mother and baby, and to a large extent this is achieved," the researchers wrote in BMJ, a British medical journal. "Maternal satisfaction with the birth experience must now be addressed."

If you want to avoid having a C-section, try to find a doctor who delivers at a hospital that has obstetricians and anesthesiologists in labor and delivery 24 hours a day, 7 days a week. Some of the most outspoken critics of the rising U.S. C-section rate blame it on doctors' convenience, not medical necessity. While that may be a bit of a stretch, even doctors themselves admit they're not always crazy about sitting around for hours as a patient's labor drags on.

In such cases, a C-section begins to look pretty attractive. But if physicians aren't pressed for time, if they have to remain in the hospital even if no one is in labor, they do fewer cesareans. Round-the-clock in-house coverage is one reason academic medical centers - hospitals that have an obstetrics residency program and are affiliated with medical schools - tend to have lower C-section rates than community hospitals.

Find a doctor who's willing to use forceps or vacuum extraction, which is rapidly becoming a lost art. Physicians adept at using those tools are dwindling in number because so-called operative vaginal deliveries have developed a bad reputation. True, in unskilled hands, operative deliveries with forceps or vacuum extraction can injure the mother or the baby. But skilled doctors can use those tools to get the baby out even more quickly than if they had performed a C-section. Yet, some obstetrical residency programs don't even train doctors in how to use forceps or vacuum extraction because older doctors got burned with malpractice suits when they used them.