How to Lower Your Chance of an Unnecessary C-Section

Sometimes a C-section is clearly the safest way to give birth. Other times, there may be room to wait, try another approach, or ask more questions before deciding. Below are steps that may lower your chance of a C-section you don't need, from choosing where to give birth through the pushing stage.

Start With Your Provider and Hospital

C-section rates and approaches to labor can vary between hospitals and practices. When choosing where and with whom to give birth, ask how they approach labor progress, induction, movement, monitoring, assisted vaginal birth, and cesarean delivery. Questions to ask:

What is your practice's C-section rate, especially for first-time, low-risk births?
What is the hospital's C-section rate?
How do you decide when labor has stopped progressing?
How do you support movement and position changes during labor?
Do you offer intermittent monitoring of the baby's heart rate for low-risk labors?
When do you use vacuum or forceps, and who on the team is trained to use them?
How do you involve patients in decisions when a C-section is being considered?

Making sense of C-section rates: The most useful number to ask about is the NTSV rate, which stands for nulliparous, term, singleton, vertex. It's the C-section rate for first-time parents giving birth to a single, full-term, head-down baby. Because it focuses on low-risk births, it's easier to compare between hospitals. The national Healthy People 2030 goal is 23.6% or lower. You can look up many hospitals' NTSV rates on the Leapfrog Group's hospital ratings site.

If you've had a C-section before, our VBAC vs. repeat C-section guide can help you understand your options.

During Pregnancy

If Your Baby Is Breech, Ask About ECV

Many babies who are breech earlier in pregnancy turn head-down on their own. If your baby is still breech later in pregnancy, ask whether you're a candidate for an external cephalic version (ECV). This is usually done around 37 weeks. During an ECV, a trained clinician uses their hands on your abdomen to try to turn the baby head-down.

ECV isn't right for every pregnancy and doesn't always work, but a successful ECV can make vaginal birth more likely. Ask:

When do you offer ECV?
What monitoring is used during the procedure?
What are the chances of success in my situation?
What happens if it doesn't work?

Some people also try other approaches to encourage a breech baby to turn, either before an ECV or alongside it:

Moxibustion is a traditional Chinese medicine practice that involves burning a dried herb (mugwort) near a point on the little toe. Some research suggests it may help, especially when combined with acupuncture, but the evidence is limited.
Spinning Babies is an approach that uses specific positions and movements meant to create more room for the baby. Many people find it helpful, but it hasn't been well studied for turning breech babies.
Chiropractic care, often the Webster technique, aims to align the pelvis and relax surrounding muscles and ligaments to give the baby more room. Some people see a chiropractor before an ECV and have found it improves ECV success, although there isn't strong research to support this.

Talk with your provider before trying any of these, and look for practitioners trained in caring for pregnant people.

Put a Suspected "Big Baby" in Context

Estimated fetal weight is just that: an estimate. A third-trimester ultrasound can be useful, but it's imprecise for predicting a baby's exact birth weight. Based on Evidence Based Birth's analysis of the research, ultrasound estimates near the end of pregnancy can be off by roughly 15% in either direction. ACOG recommends individualized counseling when a large baby is suspected.

A larger baby can increase the chance of certain complications, including shoulder dystocia (when the baby's shoulder gets stuck after the head is born), so size shouldn't be dismissed. But an ultrasound estimate alone doesn't tell you exactly how labor will go.

Understand Induction Without Fearing It

Induction is sometimes medically recommended and can be an important tool for protecting you or your baby. It can also add steps, such as medication or a device to soften and open the cervix, IV medications, more monitoring, or breaking your water. Depending on how labor unfolds, these may lead to other interventions.

You may hear this described as a "cascade of interventions." That doesn't mean induction automatically leads to a C-section. The link between induction and cesarean birth depends on why and when the induction is done, your individual pregnancy, how ready your cervix is, and how labor is managed. If an induction is recommended, ask:

Why are you recommending it?
What are the benefits?
What could happen if we wait?
What options will I have during the induction?

During Labor

Use Continuous Labor Support

Continuous one-to-one support during labor is associated with better birth experiences and a lower likelihood of cesarean birth. That support may come from a doula or another trained support person whose role is to stay with you, help with coping and positioning, and support communication with the clinical team.

A doula doesn't replace your nurse, midwife, or physician. They provide a different kind of support and can be part of the same team.

Move and Change Positions

Frequent position changes can support comfort and may help your baby move into a good position and descend. Depending on your medical situation and monitoring needs, you may be able to walk, stand, sit upright, use a birth ball or peanut ball, lie on your side, kneel, or change positions in bed.

An epidural doesn't necessarily mean staying flat on your back. Ask your nurse or support team to help you change positions safely.

Ask About Monitoring Options

If your pregnancy is low risk, ACOG considers intermittent monitoring an option. With intermittent monitoring, your nurse or midwife listens to your baby's heart rate at regular intervals instead of keeping you on a monitor the whole time. Continuous electronic monitoring has been linked to higher C-section rates in low-risk labors without improving outcomes for babies. Intermittent monitoring may also make it easier to move around. It isn't right for every labor, so ask whether it's an option for you.

Give Early Labor Time When It's Safe

Labor doesn't always follow a predictable timeline. Current ACOG guidance considers 6 cm dilation the start of active labor. Before 6 cm, labor may progress slowly. A long early phase on its own, when you and your baby are otherwise doing well, isn't a reason to diagnose stalled labor.

Once active labor begins, a slow labor isn't automatically a stopped labor. Under ACOG's criteria, labor is considered stalled (active-phase arrest) only when all of these are true:

You're at least 6 cm dilated.
Your water has broken.
Your cervix hasn't changed after 4 hours of strong enough contractions, or after 6 hours of Pitocin if contractions aren't strong enough.

If "Failure to Progress" Comes Up

Ask:

How much has my cervix changed, and over what time?
Am I in active labor yet?
How long has labor been observed?
Are my contractions strong enough?
Are there safe options to give labor more time?

During the Pushing Stage

Ask About Options Before a Second-Stage C-Section

The second stage of labor begins when your cervix is fully dilated, at 10 cm, and ends when your baby is born. It's often called the pushing stage. ACOG recommends allowing at least 3 hours of pushing for first-time parents and at least 2 hours for those who have given birth before, as long as you and your baby are doing well. Pushing longer may be reasonable in some situations.

If your cervix is fully dilated but birth isn't progressing, your options depend on your baby's position, how far down the baby has moved, how you and your baby are doing, and the skills available on your care team. In some situations, a vacuum- or forceps-assisted vaginal birth may be an alternative to a C-section. These have their own risks and aren't appropriate in every situation, but they can be worth asking about when there's time.

Ask About Waiting When Waiting Is Reasonable

If a C-section is recommended and there's time to talk, ask why now, how urgent it is, and what would happen if you waited a little longer. Our guide to C-sections lists more questions to ask.

Sometimes the answer will be that waiting would create unacceptable risk. Other times, there may be a reasonable option to continue labor, change positions, adjust support, use Pitocin to strengthen contractions, or reassess after more time.

A C-Section Is Not a Failure

You can make evidence-based choices, have excellent labor support, move throughout labor, and still need a C-section. Birth isn't completely controllable, and needing surgery doesn't mean you or your body failed.

The goal isn't to avoid a C-section at all costs. It's informed, respectful care that responds to what you and your baby need, not achieving one particular type of birth.

Sources

For education only; not a substitute for individualized medical advice. Sources reviewed for this article: