EDUCATION IS KEY TO A NORMAL AND NATURAL BIRTH
1. An elective early delivery
It turns out that carrying an infant to term has health benefits for both moms and babies. Research shows that babies born at 39 weeks or later have lower rates of breathing problems and are less likely to need neonatal intensive care. Full-term babies may also be less likely to be affected by cerebral palsy or jaundice, have fewer feeding problems, and have a higher rate of survival in their first year. Some research even suggests that full-term infants benefit from cognitive and learning advantages that continue through adolescence.
Perhaps because late preterm infants have more problems, mothers are more likely to suffer from postpartum depression. In addition, the procedures required to intentionally deliver a baby early—either an induced labor or a C-section—also carry a higher risk of complications than a full-term vaginal delivery. “There is just much more chance of things going wrong if you interrupt the normal course of pregnancy,” says Catherine Spong, M.D., chief of the pregnancy and perinatology branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Of course, some babies arrive sooner than expected and complications during pregnancy, such as skyrocketing blood pressure in the mother, can make early delivery the safest option. But hastening the conclusion of an otherwise healthy pregnancy—even by a couple of days—is never a good idea.
The rate of early deliveries varies widely among hospitals, as demonstrated in the table below of all six hospitals in Utah that report that data to the Leapfrog Group. It shows the percentage of early deliveries in each hospital that were done without medical reason. See the rates of planned early deliveries for the hospitals in your state on the Leapfrog website.
2. Inducing labor without a medical reason
The percentage of births resulting from artificially induced labor more than doubled from 1990 to 2008. “In many ways the system has become centered on convenience rather than evidence-based care,” says Carol Sakala, Ph.D., director of programs at Childbirth Connection. She points out that it’s no coincidence that more babies are born on Tuesdays than any other day of the week. “The births are scheduled so that parents and providers can all be home by the weekend.”
But whether artificially induced or spontaneous, labor is labor, right? “Absolutely not,” says Debra Bingham Dr.PH., R.N., vice president of the Association of Women’s Health, Obstetric and Neonatal Nurses. She points out that women who go into labor naturally can usually spend the early portion at home, moving around as they feel most comfortable. An induced labor takes place in a hospital, where a woman will be hooked up to at least one intravenous line and an electronic fetal monitor. In addition, most hospitals don’t allow eating or drinking once induction begins.
For example, a 2011 study found that women who had labor induced without a recognized indication were 67 percent more likely to have a C-section, and their babies were 64 percent more likely to wind up in a neonatal intensive care unit, compared with women allowed to go into labor on their own.
Induction is justified when there’s a medical reason, such as when a woman’s membranes rupture, or her “water breaks,” and labor doesn’t start, or when she’s a week or more past her due date.
3. A C-section with a low-risk first birth
The best way to reduce the number of Csections overall is to decrease the number of them among low-risk women who are delivering their first child. That’s because having an initial C-section “sets the stage for a woman’s entire reproductive life,” says Main. “In this country, if your first birth is a C-section, there’s a 95 percent chance all subsequent births will be as well,” he says.
A C-section is major surgery. So it’s no surprise that as rates for the procedure go down, so do the numbers for several complications, especially infection or pain at the site of the incision. Rare but potentially life-threatening complications include severe bleeding, blood clots, and bowel obstruction. A C-section can also complicate future pregnancies, increasing the risk of problems with the placenta, ectopic pregnancies (those that occur outside the uterus), or a rupture of the uterine scar. And the risks increase with each additional cesarean birth.
Babies born by C-section can be accidentally injured or cut during the procedure and are more likely to have breathing problems. They are also less likely to breastfeed, perhaps because of the challenges of starting in a post-surgical setting.
In some situations, such as when the mother is bleeding heavily or the baby’s oxygen supply is compromised, surgical delivery is absolutely necessary. But women can maximize their chances of avoiding an unnecessary cesarean by finding a caregiver and birthing environment that supports vaginal birth.
When choosing a practitioner and hospital or birthing center, ask about C-section rates, particularly rates for low-risk women having their first child. The target rate for that population should be around 15 percent, according to ACOG. Although it can be difficult to find a hospital with a C-section rate that low, you might be able find one that meets the more modest goal of about 24 percent, which was set by the government’s Healthy People 2020 initiative.