How to Avoid C-section and Have a Vaginal Delivery

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in this video I will discuss five tips

to reduce your risk of a c-section

coming up

hey everyone dr. Wes Davis coming to you

today I make weekly videos with tips and

tricks to provide you with the best

available evidence based information to

give you the best possible outcome for

you and your baby so if you're new here

please consider subscribing okay so no

one wants to have a c-section if they

don't have to so today we're going to

discuss five tips to reduce that risk

tip number one gaining too much weight

has been shown to increase the risk of

c-section by up to 60% whenever possible

you want to gain the amount of weight as

recommended by the Institute of Medicine

and these are BMI body mass index based

recommendations so I'm going to put a

chart up here that shows you what the

typical recommendations are for

underweight average weight overweight

and obese and you can see that the more

towards the overweight and obese you are

the less weight is recommended for total

pregnancy weight gain tip number two

induction of Labor and a first-time mom

might increase the risk of c-section if

you do have to be induced then I just

say well it'd be nice if you have what

we call a favorable cervix and I'll put

a little graphic up here that talks

about the bishops core it kind of

explains that but if you have a bishop

score of around ten then you can be

pretty well assured of successful labor

induction now sometimes it just just has

to be done and that's okay if there's a

clear medical indication deuced labor

especially in the first-time mom may

take longer than spontaneous labor

don't let it feel like oh it's been so

many hours nothing's happened that's

normal and we're going to talk about

that in a minute a little bit more

detail new information will be coming

out later this year on induction of

Labor and first-time moms it's called

the arrive trial the study has been

completed but the results have not yet

been published so we don't really know

from that study whether or not induction

of Labor and first-time moms increases

or decreases c-section rate or has any

other good or bad outcomes as a result

so I recommend stay tuned when that

comes out I will definitely be

discussing it in a future video tip

number three give it plenty of time just

thought normal labor was for a

first-time mom versus a mom who's had

babies before

different than what we've been taught

for years and years there was this thing

they talked about called the Freedman

curve is from like the 1950s or

something like that super old really

hadn't been validated in a modern

population couple things that have

changed over the years one of which is

the use of epidurals is much more common

now overall people are having babies at

older age Freedman curve does not really

apply anymore we really need to

understand what normal labor progress is

in this era of Medicine this idea of a

failed induction so that they tried to

induce me nothing ever happened so I had

to have a c-section this really should

be a very unusual situation it is

currently defined as 24 hours of no

cervical change the waters been broken

and you're on pitocin having

contractions every three minutes for 24

hours if there's no cervical change

that's now defined as a failed induction

and I can tell you that that is

extraordinarily rare much more likely

would be either that the moms condition

or the baby's condition deteriorated the

other thing we talked about is failure

to progress and you need to think of

those in the first stage of labor and

the second stage of labor now the first

stage of labor really have to break down

into latent phase labor and active phase

labor basically we're talking about

active labor here so that's now defined

as being at least six centimeters so a

rest of dilatation first stage arrest is

now defined as four hours of no cervical

change beyond six centimeters if you

have what's called an intra and pressure

catheter that shows adequate

contractions or six hours if you either

don't have the pressure catheter or the

contractions are not adequate for

whatever reason so really we're talking

no change for four to six hours once

you've gotten to at least six

centimeters those don't happen a whole

lot now they still happen or you're a

big baby

baby's position isn't right our baby is

not tolerating labor again something

like that this is whether you're being

induced or whether this is spontaneous

labor that really you're not in active

labor until six centimeters and anything

less than that these numbers don't apply

and I have let people be in latent phase

labor for up to 24 hours you will on

occasion have a little bit higher risk

of either fever

labor or infection but that's not an

indication for a c-section we can treat

the infection with antibiotics babies

can be treated after delivery with

antibiotics arrest in the second stage

is when you've become completely dilated

and now we're talking about no descent

of the fetal head over a certain period

of time so and that is broken down by

whether it's your first baby or not your

first baby so first babies so that's

called nolan bris you've never had a

baby four hours of no descent or

rotation in the fetal head if you have

an epidural and three hours if you don't

have an epidural and then if you're a

multi-purpose patient so you've had

babies before then the numbers are three

hours or more if you have an epidural

and two hours if you don't when you

start using those kind of criteria

you're gonna call c-section a lot less

frequently for a failure to descend or a

second stage arrest tip number four if

your baby's breech at 36 to 37 weeks

consider external cephalic version

that's where we rotate the baby from

breech to try to get the head to come

around that could reduce your risk of

c-section by up to 40 percent so it

works about half the time but of course

not every single person that has a

successful version will ultimately have

a vaginal delivery the baby's breech

talk to your doctor about possible

external cephalic version tip number

five consider operative vaginal delivery

/ c-section when it's appropriate when

used appropriately following the

guidelines they are considered a safe

and effective way to reduce your risk of

c-section one issue can be that some

newly trained physicians might not be as

comfortable doing operative vaginal

deliveries the number of cases that

residents are doing a training now is a

lot less than say when old gray-haired

guys like me trained back in the day so

we had a lot of experience with

operative vaginal deliveries feel very

comfortable using forceps and vacuum but

some people might not so that's an

important one to talk to your doctor

about even in the beginning if you're

trying to do everything you can to

reduce your risk of a c-section then you

want to know well how comfortable are

you what's your experience with

operative vaginal delivery because that

is an option in the appropriate

situation is safe and effective and

could reduce your risk of the c-section

another thing to mention people asked

frequently is does

Durrell increase the risk of c-section

and the answer is no it doesn't there's

never been a study that showed an

increased risk of c-section from an

epidural and take a little longer to

push a baby out if you have an epidural

than if you don't but that's okay as

long as you're aware of that and the

last thing to tell you is that heart

rate monitoring is very important it is

the standard of care to monitor moms in

labor continuous monitoring might

actually increase the risk of c-section

and not providing any additional benefit

over intermittent monitoring now that's

mostly talking about spontaneous labor

we have to monitor moms continuously if

you're being induced or if you have

other complications preeclampsia

bleeding things like that because the

fetal heart rate tracing will often show

us that there's a problem before it

becomes a big problem but if we're

talking about just plain old spontaneous

labor everything's going fine then in a

minute intermittent monitoring is

perfectly fine it is considered equally

effective as continuous and it might

actually reduced the risk of c-section

because sometimes you see things on the

monitor that they're transient they

don't mean anything and they kind of

start a chain of events of interventions

that could ultimately lead to a

c-section win if you just let things be

they would have been fine if you are

being induced or having other

complications or you're on pitocin then

the main thing that really could reduce

your risk of c-section is be sure you're

delivering in a facility that has nurses

that are accredited to provide

electronic fetal monitoring then what it

basically does is provides a framework

for interpretation in the fetal heart

rate tracing it provides a standardized

way to categorize the findings that are

seen and that allows for clear

communication between the nurses and the

doctors and also leads to more

standardized interventions based on what

is being seen that could also reduce

your risk of c-section I hope these tips

help reduce your risk of a c-section in

the future if you have questions please

feel free to put them in the comments


and thanks for watching and have a great