To lower your risk of a C-section, take the following steps.
• Find out your hospital’s C-section rate. Start with our hospital Ratings. If your hospital is not included, ask the person who will deliver your baby about the hospital’s rates. Remember: lower is usually better. The average national C-section rate for low-risk deliveries, the measure used in our Ratings, is about 18 percent, a rate we consider too high. A more reasonable figure is 12.6 percent, the national average in 2000 and a benchmark we used to develop our Ratings. (Note that the average total C-section rate, which includes all cesarean deliveries not just low-risk ones, is 33 percent.)
• Choose your provider carefully. It’s good to know the C-section rates for your doctor, too, so ask whether his or her practice tracks their C-sections. “Even if they don’t know the exact percent, providers should be able to articulate their philosophy about supporting vaginal birth,” Caughey said. Also ask how the new ACOG/SMFM guidelines may affect the practice’s approach to labor and delivery. If your provider is unaware of the new standards, or is dismissive of them, you may want to find a different one.
• Watch your weight. If you are overweight, strive to shed excess pounds before becoming pregnant. Overweight and obese women have a much higher risk of C-section than normal weight women. And once you’re pregnant, talk with your provider about the healthy weight gain for you. Women who are overweight should plan to gain less than those who are not.
• Stay fit. Women who take part in structured exercise during pregnancy are less likely to need a C-section, research suggests. Talk to your health care provider about appropriate forms of exercise, such as walking, swimming, and aerobic or yoga classes for pregnant women.
• Don’t rush things. Doctors should not try to induce labor unless there’s a good medical reason—for example, if a woman’s membranes rupture (her “water breaks”) and labor doesn’t start on its own or she is two weeks overdue. Trying to induce labor before a woman’s body is ready can lead to surgical delivery if labor doesn’t progress.
• Don’t worry too much about big babies. The possibility of a large baby is frequently used to justify a cesarean delivery, but that’s not warranted, according to the new ACOG/SMFM guidelines. To begin with, methods used to assess the baby’s weight toward the end of the pregnancy are not very accurate. Also, babies typically have to be 11 pounds or larger to justify a C-section, according to Caughey.
• Get support during labor. Consider hiring a doula, a trained birth assistant who can provide physical and emotional support throughout labor and delivery. Women who have continuous support from someone who is not a friend, family member, or a member of the hospital staff labor for shorter periods and are less likely to need interventions, research shows. Ask your insurer if it will cover doula care.
• Ignore the clock. The new ACOG/SMFM guidelines call for allowing more time in each phase of labor and delivery. In general, decisions on whether to intervene should be based on how well mothers and babies are doing, not how much time has passed.
For additional steps you can take before and during pregnancy to help ensure the best possible outcomes, see our report "What to Reject When You’re Expecting."
And see these additional resources
American College of Obstetricians and Gynecologists Patient Resources
American College of Nurse Midwives Patient Resources
March of Dimes Pregnancy
March of Dimes Nacer Sano
Office of Women's Health Pregnancy Resources