Cesarean births, or C-sections, are one of the most commonly performed surgeries and can help save lives when medically necessary. However, if you have a low-risk pregnancy and having a C-section isn’t part of your birth plan, you may be wondering if there is anything you can do to help reduce your risk of needing one during labor.

In order to know what could help reduce your risk, it’s important to know what risk factors make delivery via C-section necessary.

“Typically, a vaginal delivery is preferred whenever safely possible for both mom and baby. However, there are a few circumstances that require us to go forward with a C-section, whether it’s prior to active labor or during active labor,” says Sheri Puffer, M.D., an OB/GYN and physician on the medical staff at Texas Health Arlington. “One reason is if the baby is not head-down, or what we call ‘breech,’ which is when baby’s buttocks or feet are situated first at the birth canal. That’s a big reason for safety and many OBGYNs will not deliver a single baby in any other position but head-down. It’s different if it’s more than one baby, though.”

Some additional reasons for a primary C-section include:

• If the patient has had a prior uterine surgery, which can be a risk factor for uterine rupture during active labor.
• An anatomical condition that would interfere with the delivery of a baby vaginally, such as a vaginal septum, placenta previa, a condition in which the placenta partially or wholly blocks the neck of the uterus, or placenta accrete, a condition in which the placenta attaches itself too deeply and too firmly into the uterus.
• Your baby is a certain weight or very large.
• Some maternal health conditions like high blood pressure, diabetes, heart disease, or HIV may increase the risk of complications during delivery, making a C-section delivery necessary.

“Another factor that may make you eligible for a primary C-section is a prior fourth-degree laceration from a prior delivery,” Puffer says. “However, if you have had a prior major laceration and you want to try to deliver vaginally again, we’re more than happy to try to make that happen for you. But if you prefer to avoid that risk again, we totally understand and will happily perform a C-section for you.”

Many women experience tears during childbirth. The severity is defined by the depth of the tear. First-degree tears are small tears in the skin and usually heal naturally. Second-degree tears affect the muscle of the perineum (the area between the vagina and the anus) and skin. Second-degree lacerations typically require stitches. A third-degree tear is a tear that extends into the muscle that controls the anus.

While rare, a fourth-degree laceration is the most severe, involving the area surrounding the vagina, the skin and muscles between the vagina and anus, the anal sphincters (the muscles that surrounds your anus) and into the anus. All tears are fixed shortly after having your baby. 

There are some conditions that may come up during labor that may also require an emergency C-section, such as:

• Your labor isn’t progressing, whether this means it’s too slow or stops.
• The umbilical cord is pinched or you have umbilical cord prolapse. This is when the umbilical cord slips into the vagina before the baby.
• Your baby is in distress. This means he isn’t getting enough oxygen or his heartbeat may not be regular.
• Your baby has certain birth defects, like severe hydrocephalus. This is when fluid builds up on your baby’s brain. It can cause a baby’s head to be very large. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works.

How to Reduce Your Chances of a Cesarean

There are a few things you can do during pregnancy and/or during labor that can help increase the odds of delivering vaginally.

• Prenatal care: Getting regular prenatal care can help detect and manage any potential complications that may increase the likelihood of needing a C-section.
• Proper nutrition and exercise: Eating a balanced and healthy diet and staying active throughout pregnancy can help maintain good health and prepare the body for labor.
• Watching your weight: Many U.S. women gain too much weight during pregnancy. Gaining too little weight may also make you susceptible to a C-section. Ask your doctor what your weight gain goal should be.
• Labor preparation classes: Attending prenatal classes that teach relaxation techniques, breathing exercises, and labor positions can help prepare women for labor and reduce anxiety, which may reduce the likelihood of needing a C-section.
• Relax: Minimize stress with yoga and meditation. Discuss your fears and concerns with your provider.
• Labor support: Having a trusted labor support person, such as a partner or doula, can provide physical and emotional support during labor and help women cope with pain, which may reduce the likelihood of needing a C-section.

“Unfortunately, there’s not a magic answer and everyone’s pregnancy is different,” Puffer adds. “These are some things you have a bit more control over, and these things can help you prepare for the act of labor, which can be quite grueling. But that’s really all you can realistically do ahead of time because there are so many other aspects out of our control.”

If You Can’t Avoid a C-Section, Embrace Your Experience

It's important to note that even with the best preparations and intentions, sometimes a C-section may still be necessary for the health and safety of the mother and baby.

“Of course, if we go with a natural delivery plan and then circumstances pop up that preclude us from going forward with that, we are lucky to have the ability to perform c-sections safely in our country,” Puffer says. “However, I know the shame so many women can feel if they end up having to have a medically necessary C-section. Unfortunately, we see that all the time. They may have wanted a vaginal delivery very badly and for whatever reason, that wasn’t possible.

“I always tell my moms that the No. 1 goal is a safe baby and a safe mom. And if you have that, then you are blessed and it does not matter how that baby was brought into this world,” she adds. “If you have a happy, healthy baby in your arms, and a happy, healthy mom, that is the goal for everyone involved.”

Additionally, Puffer recommends reaching out for support if you’re struggling with your labor and delivery experience.

“We, as a society, do put a lot of pressure on moms for so many things,” she says. “So, I just urge people to always reach out to their doctor after having their baby if they’re feeling down because it’s very common; 40% of women experience post-partum depression and mode of delivery can contribute to that. Do not be afraid to ask for help.”

For more help and guidance about what to expect during your pregnancy, visit Women and Infant Services and join the Texas Health Moms Facebook page, a private group where you can network with other moms, swap ideas and share helpful advice.