Clinical Interventions for Preventing Unnecessary Cesarean Births

​Cesarean section is a lifesaver. Like other surgeries, though, it carries risks for both the mother and the baby. As such, it is recommended it be done only when necessary.

Also known as a C-section, cesarean birth is the delivery of a baby through an incision of the abdomen and the uterus. There are instances where a C-section is mandatory. However, in some cases, pregnant mothers simply prefer to go under the knife, even when it’s unnecessary. Unnecessary C-sections needlessly expose pregnant mothers to risks associated with the surgery.

Some of the C-section risks include adverse reaction to anesthesia, cardiac arrest, shock, blood clots, excessive blood loss, and wound infections. Exposure to these risks is three times higher for cesarean deliveries than for vaginal births. As such, vaginal birth is considered the safer birthing option.

But there are some instances where attempting vaginal birth is riskier than performing a C-section, such as when the baby is breech. A fetus is said to be breech when it’s positioned unnaturally at the time of birth. For example, it can be facing upwards, with its buttocks blocking the birth canal. Breech births have been found to complicate 3.8 percent of pregnancies.

But breech can be resolved, reducing the need for going the surgical route, thanks to external cephalic version (ECV). In ECV, the fetus is realigned by gently applying pressure on the abdomen and moving the baby’s head to the pelvis. This strategy has been used to successfully reposition breech, transverse (baby lying across the uterus), and oblique (baby’s head is in the mother’s hip) positions.

Maternal weight (both excessive weight and underweight) increases the need for cesarean birth. This can be addressed by educating pregnant mothers on the importance of maintaining recommended weight during pregnancy. Eating well and exercising are some of the recommended strategies for ensuring expectant mothers are within the appropriate weight range at the time of birth.

The Institute of Medicine (IOM) recommends women of low weight gain about 27.5 to 39 pounds during pregnancy, while those with normal weight can add 25 to 35 pounds. For those already overweight, though, the ideal weight gain should be from 15 to 25 pounds. The maximum weight a woman who is obese should gain during pregnancy is just under 20 pounds.

Also, a pregnant woman with a history of herpes simplex virus is more likely to undergo a C-section. This helps prevent the chances of the mother infecting the baby during vaginal delivery. Limiting C-sections due to the existence of herpes simplex virus to mothers with active genital infection during labor may help prevent unnecessary cesarean births.

As such, it’s recommended pregnant mothers with a history of herpes simplex virus receive drugs for suppressing the virus three to four weeks before the expected date of delivery. Suppressive therapy is recommended for all mothers with a history of herpes simplex virus, even those with no active infection.

The rate of C-section deliveries tends to also be higher among pregnant women expecting twins. Barring other factors that may complicate vaginal delivery, such as fetal distress due to low levels of amniotic fluid, maternal anemia, or insufficient oxygen, vaginal delivery is still a safer option for mothers with twin gestation.

Biased or alarming communication on the part of physicians and other attending staff may create the impression that a situation is worse than it really is. Some of the subjective terminologies used that may frighten expectant mothers into preferring C-section to vaginal birth include “dicey” or “dippy” when describing fetal heart tracings. Objective communication during counseling helps pregnant mothers make informed decisions.

Ultimately, the decision to have a C-section is up to the pregnant mother. However, presenting expectant mothers with all the possible options and furnishing them with all the information necessary to make an informed decision may reduce instances of unnecessary C-sections.

Dr. Odianosen Oriaifo

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