9 Changes We Must Make To Increase Vaginal Birth Rates

Many new mothers do not plan to give birth via caesarean section, yet around one in three women in Australia and the United States will give birth this way. When medically necessary, C-sections can save lives. When conducted as an elective procedure, however, the risks outweigh the benefits. To increase the rate of vaginal births, here are nine changes we need to make:

#1. Low-risk Providers for Low-risk Mothers

Midwives provide wonderful care for low-risk women. They are trained to support normal physiological birth. Midwifery care is linked to improved maternal and fetal health outcomes, including lower C-section rates. In some developed countries, midwifery care is the norm, while obstetricians are only needed for women experiencing complications. Many of these countries have higher rates of vaginal births when compared to Australia.

While midwives are trained to help facilitate normal physiological birth, obstetricians are more likely to be trained to manage labor. They are also trained surgeons. This training is excellent and needed when caring for a high-risk mother, but is often unnecessary for low-risk women. Therefore, some women may end up with procedures that they really don’t need.

How a professional is trained will influence their view of C-sections. When trying to increase vaginal births, it’s important to make midwifery care the norm for low-risk women.

#2: Use More Doulas

Women who utilize doulas not only report more satisfaction with their labor and birth experience, they also increase their chances of a vaginal birth. The ACOG study linked above shows continuous labor support reduces C-sections, and other studies show trained doulas dramatically reduce C-section rates.

Having a doula present increases:

• The likelihood of spontaneous vaginal delivery

• Satisfaction with the birth experience (for both mother and partner)

• Rates of breastfeeding at 6 weeks postpartum

• The mother’s self-esteem

It decreases the likelihood of:

• Utilizing medicinal pain relief, including an epidural

• Labor induction and augmentation with synthetic oxytocin (which does not act the same way as natural oxytocin)

• Vacuum or forceps assisted birth

• C-section birth

The evidence speaks for itself. Continuous labor support from a doula can help increase our vaginal birth rates. We need doula care to become the norm, and we need teamwork between all care providers, so birth professionals can all play their role (or step aside) as needed.

#3: Encourage Movement

Before hospital birth became the norm, many women stayed active and moving during labor. Now it’s not uncommon for women to go to the hospital early in labor and remain in bed.

Barring medical necessity, staying in bed is not an evidence-based practice. Moving during labor helps women cope with contractions and facilitates baby’s movement into the pelvis and through the birth canal. Coping with contractions using gravity and facilitating easier movement for baby can help increase vaginal birth rates.

#4: Limit Induction and Augmentation

Choosing baby’s due date and speeding up labor can seem appealing, but they are not without risks. Mother and baby fare much better when labor begins and progresses naturally. If providers use only evidence-based practices when deciding to induce and augment labor, we could see an increase in vaginal births.

When medically indicated, it’s wonderful that we have the ability to induce or augment labor, and improve outcomes in high-risk situations. Unfortunately, the current rates of induction and augmentation do not reflect that they’re being used only when medically indicated. The use of synthetic oxytocin, a common induction and augmentation drug, is not considered appropriate for elective inductions.

#5: Promote Awareness of Birth Options

Many first-time expectant mothers assume a hospital delivery with an obstetrician is their best, or only, option. However, many other options exist. Normalizing these other options can play a key role in increasing vaginal deliveries.

Delivering in the hospital with a certified nurse midwife or a family physician, instead of an obstetrician, can increase the likelihood of a vaginal delivery. Like midwives, family physicians use fewer routine interventions and are not trained surgeons. Their approach to care during labor results in lower C-section rates, just 15.4 percent.

Planned out-of-hospital delivery with a skilled midwife is a safe option for low-risk women. Some freestanding birth centers have a spontaneous vaginal birth rate of over 90 percent! A recent study confirmed the safety of midwife-attended home births for low-risk women and found a C-section rate of just 5.4 percent.

Obstetricians have a key role in maternity care. It is important that we have access to life-saving interventions when medically necessary. Statistics, however, tell us that access to other birthing professionals and locations other than hospitals—even at home—can help increase vaginal deliveries.

#6: Encourage Natural Comfort Measures

While IV narcotics and epidurals provide pain relief, they also have side effects and limitations. Once medicinal pain relief is administered, most women are required to stay in bed and have limited mobility. This removes or limits the ability to assist the baby in its decent with mom’s movement. Epidurals can also make it difficult for mom to feel the urge to push, which can increase the risk of needing assisted delivery.

Labor is work though, and women need coping techniques and comfort measures. Encouraging and educating about natural comfort measures might increase vaginal delivery rates. Hydrotherapy, massage, self-hypnosis, the use of warm and cool compresses, aromatherapy, counterpressure, position changes, and more can help moms cope with contractions while adding little to no risk.

#7: Keep Women off Their Backs

For most of human history women did not give birth in the supine position. It wasn’t until the 1700s that women began giving birth lying down. When a woman delivers on her back, labor is often more difficult.

There are many benefits to giving birth in an upright position, including:

• The assistance of gravity

• More efficient contractions

• Less pain

• More pelvic space for baby to make its way through

• Shorter labor

These benefits can help increase vaginal births. Giving birth in an upright position as the norm is an important step in reducing C-section births.

#8: Normalize V BAC

One major contributing factor to the rise in C-sections was the belief that a repeat C-section birth is usually safer than a vaginal birth after a caesarean (VBAC). Current research tells us this is not the case.

While a VBAC has risks, a C-section birth is not without them. Women have been conditioned to fear a “uterine rupture” after a C-section, when the likelihood of this occurring is actually very low—and the chances of it being fatal is even lower. Yet women are not told about uterine rupture being a possibility while having an induction of labor. Why is this so?

Women should have access to evidence-based information regarding VBAC versus C-section. Many women believe a repeat C-section birth is their only option, or that choosing a VBAC is extremely dangerous. Some women are well-informed and desire a VBAC, but are unable to find a provider willing to support her. Giving women access to VBAC information and supportive care can help drastically reduce C-section rates.

#9: Build Confidence in Natural Birth

Birth is a normal bodily process that often unfolds well with a healthy mother and baby as the result. This may be hard to believe with the current high level of interventions, but it’s true. The U.S. invests an absolute fortune into maternity health care (more specifically, technology), but has some of the highest newborn and maternal death rates in the world. We can do better, and we can save more lives, with less.

If providers, expectant parents, and society begin to view natural physiological birth as normal, we will begin to see more vaginal births. What we believe influences how we practice, the decisions we make and even how our own labors unfold.

When providers are trained to view physiological birth as the norm, and necessary intervention as the exception, their care will better facilitate vaginal births. When expectant mothers are educated about normal physiological birth, remain active participants in their care, and make evidence-based choices during childbirth, they are likely to have a healthier birth experience.

If society begins to view birth as normal, we will see positive birth in the media, building our confidence. We will also have friends and relatives encouraging and building us up, rather than creating fear around natural birth.

Our current C-section rates are simply too high, meaning many mothers are having unnecessary major surgery. By being informed and changing our perceptions about birth, we have the ability to change this trend. We are extremely fortunate to have medical support available at birth when we need it. But when used unnecessarily, medicalized birth interventions often cause more harm than good.

Originally published on BellyBelly.com.au.