Cesarean Awareness

The cesarean rate in Washington state is among those states that are alarmingly high. The CDC reported the average in Washington to be 28.4% for 2006, with many Seattle area hospitals topping 30%.  That figure may mean that half of all c-sections performed could have been unnecessary surgeries. Seattle Cesarean Rates from Transition to Parenthood

How can this rate be reduced to the recommended 10-15% that are probably necessary cesareans? We as women, mothers, and support people need to speak out and educate each other about this important issue.

Here are some things you can do to reduce your chances of undergoing an unnecessary cesarean.

1. Be sure you have chosen a birth environment that makes you comfortable.  If you would rather birth in a birth center or at home, don't let others opinions that the only safe place to birth is a hospital influence you. There are plenty of resources to help you determine the most appropriate place for your labor. Whatever location you choose, be sure to find out all the information and policies you need to make your decision including the cesarean rate and the circumstances in which a cesarean may be performed.

2. Carefully choose your health care provider.  This person will be caring and supporting both you and your baby throughout your pregnancy and during your labor and delivery. You don't need the added stress of not being confident in your provider during your labor.

3. Have a birth plan. Make sure your health care practitioner understands and is supportive of your choices.  There are many examples and forms available in pregnancy books or online and may contain information from the atmosphere and music to pain control and types fetal monitoring to be offered during labor. Interactive Birth Plan

4. Be comfortable with the support people who will be present at your birth. Explore the option of a birth doula if you feel you need the extra support of someone with experience. CBI Find a Doula.  A doula can be especially helpful for a home birth before your midwife arrives, and at hospital births in which a doula may help you ensure your birth plan is followed and everything going on around you is explained to you.  Again, be sure you are comfortable with the person you have chosen, and spend plenty of time before your due date getting to know this important person.  Also, be sure those people you would rather not have present during your labor understand your request. This may take some explaining as to why you need your space and having your partner or doula to help with this discussion could be a major benefit.

5. If you are considering the option of having an epidural or other type of pain control or a labor induction, be sure you get the proper education and information of what to expect during labor following the administration of the medication.

6. Address any fear surrounding childbirth and/or parenting. In many cases, if these worries are not addressed before labor, the extra stress of fear may hinder your labor at this vulnerable time.

7. Maintain a positive body image. Accept and appreciate the strengths of your body ability to grow and birth your child. Though labor is a tremendous process, it is the rare case in which a woman's body is not able to birth naturally. You may need to separate yourself from those who are not supportive of your choices until after your baby is born, these people will not be supportive for you during your pregnancy. Chances are, though, if you act and speak confidently in your choices, people will respect your decisions even if they don't agree with you.

8. Special note for VBAC (vaginal birth after cesarean). It is possible to birth vaginally after previous cesareans. If your health care provider is not supportive of your wishes, find someone else. There is lots of support for those of you in this position! ICAN Homepage 

Acupuncture in Pregnancy and Childbirth:
 It’s not just for nausea anymore
By Tristin McLaren, L.Ac., MSA 
(as seen in Northwest Baby & Child Magazine August 2007)

The journey through the nine months of pregnancy may be full of many ups and downs as your body changes in response to your little one nestled safe inside your womb. If you’re looking for alternative therapies to help your pregnancy related discomforts, acupuncture may be of benefit to you. Chinese Medicine has helped women with a range of conditions including nausea and vomiting, threatened miscarriage, anemia, pre-eclampsia, and breech positioning, as well as a method of pain control during labor, and many more. Acupuncture alleviates a variety of conditions by addressing the underlying cause of imbalances within the body, however, these treatments are not a substitute for medical care by a licensed midwife, certified nurse midwife, or obstetrician and some of these conditions should only be treated with concurrent care by your prenatal care provider.

Acupuncture is a system of healing, believed to have originated in China over 2000 years ago, that utilizes very fine needles in specific points on the body to align energy patterns and restore energy and harmony throughout the body. The Acupuncture points, or acupoints, lie on pathways called Meridians that cover the body and direct the flow of energy through the many body systems. During pregnancy, major shifts in the energy and blood flow occur all over the body resulting in the variety of symptoms women experience. 

For the duration of the first trimester, conditions women commonly seek treatment for include nausea, vomiting, insomnia, and fatigue. In addition to these more familiar discomforts, acupuncture can also assist in cases of threatened miscarriage. Though it won’t help prevent a miscarriage in which the embryo would be ultimately unviable, such as those with genetic abnormalities, it can help to promote an optimum environment within the womb for an otherwise healthy pregnancy. 

Though the second trimester is typically the most problem free, some women begin to feel the effects of the growing fetus such as heartburn, constipation, low back pain, pelvic pain, and sciatica. Some women may also begin to experience iron deficient anemia at this time, which is detected by your prenatal care provider in a routine blood test. Australian midwives have noted that women receiving acupuncture and moxibustion, or moxa, (the warming of acupoints with herbs) in addition to iron supplements showed a greater increase in iron levels than women using iron supplements alone (Betts, Essential Guide to Acupuncture in Pregnancy and Childbirth). Another condition that may be stabilized with acupuncture is pre-eclampsia, also known as pregnancy induced hypertension (PIH). When acupuncture treatment is sought as an early intervention, success at controlling blood pressure and decreasing edema (swelling in the ankles, hands or face) can often be achieved. 

Common third trimester conditions acupuncture may alleviate include, hemorrhoids, aches and pains, and leg cramps. In addition, correction of breech positioning may be accomplished with acupuncture techniques in otherwise healthy pregnancies. Treatment includes a combination of acupuncture and moxa begun between weeks 33-34. These techniques have demonstrated a success rate of over 70% in many studies which have been published in well respected medical journals such as the Journal of the American Medical Association (JAMA). Furthermore, women seeking non-chemical methods of labor induction should consider acupuncture. If your prenatal care provider has recommended medical induction, acupuncture may be used two-three days prior to the scheduled induction as an alternative, gentler method of induction. Even in cases in which women did not go into labor as a result of the acupuncture, those who received at least one treatment prior to the medical induction, had an easier labor with chemical induction as opposed to those using only medical induction. 

During labor, acupuncture may be used as a method of pain control or to help a stalled labor continue to progress. Acupuncture has been shown to increase endorphin release and induce relaxation to promote less painful contractions and increase relaxation of the cervix for optimal dilation. “Acupuncture For Prebirth Treatment: An Observational Study of its use in Midwifery practice” published in Medical Acupuncture 17/3, May 2006 reported that in women undergoing regular acupuncture treatments throughout their pregnancy: “When compared to the local regional rate there was a 35% reduction in the number of inductions, (for primigravidea women this was a 43% reduction) and a 31% reduction in the epidural rate. When compared to local midwifery practice there was 32 % reduction in emergency Caesarean Sections and a 9 % increase in normal vaginal births.” Depending on the acupoints utilized during labor, traditional acupuncture needles may be used, or a smaller type of needle called a press tack or rice grain needle, may be inserted and taped in place for the duration of the labor.

In general, women receiving regular acupuncture treatment throughout their pregnancy often experience not only a smoother and more stress free pregnancy, but usually a smoother, more efficient labor. Due to acupuncture’s ability to promote a relaxed state, blood circulation maintains a more optimal flow and hormones maintain a healthier balance resulting in a more comfortable pregnancy. It has also been observed that babies born to women who receive regular acupuncture during pregnancy are healthier and happier babies (there is no medical evidence for this last one, but it seems to be true!)

Videos on Acupuncture in Pregnancy:

Acupuncture for Labor Pains

Acupuncture in Pregnancy

Acupuncture for Pelvic Pain

Useful Links:

Debra Betts research page

Bastyr University article-"Acupuncture Eases Labor Pain"

Bastyr University article-"Childbirth: Life's Most Natural Moment"

Acupuncture Today article-"Acupuncture Helps Relieve Pain During Pregnancy"

Dr. Paul Magarelli on Acupuncture to increase IVF success


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