Abby Block, CD(DONA), CBC

Doula & Breastfeeding Support ~ Serving Brooklyn & NYC

c-section prevention

The Cesarean Rate Epidemic

Abby BlockComment

This article looks at the current rates, state, and climate of Cesarean Births in the U.S. It provides statistics and rates, reasons for Cesareans, as well as the associated risks. 

Cesarean delivery may be a safe alternative to vaginal delivery but its use in 1 of 3 women giving birth in the US seems to high.

An excerpt discussing the rising rates and unusual number of Cesarean rates below:

"One possible reason for the rise in the cesarean delivery rate may be that there has simply been a rise in the need for cesarean. The most common indication for a primary cesarean is cephalo-pelvic disproportion, or arrest of progress in labor. It is unlikely that maternal pelvis size has changed over the past 3 decades, but it is possible that birth weight has increased. In fact, evidence suggests that rates of macrosomia have increased over the past 2 decades.8 Other issues that contribute to increasing rates of cesarean delivery, possibly through the mechanism of birth weight, are maternal obesity and gestational weight gain.9,10 Without question, the proportion of obese women has increased over the past decade and higher weight classes are associated with even higher rates of cesarean.11,12 In addition, increased gestational weight gain has been associated with cesarean delivery and is commonly above standard guidelines.13

Another reason for increasing cesarean rates may be a rise in elective cesarean delivery, also known as cesarean delivery by maternal request (CDMR). Because there was no ICD-9 code for CDMR, it is unclear what proportion of cesareans are due to it. One recent study, however, estimated the proportion as high as 4% in the United States.14 Interestingly, CDMR is more common in other countries, such as Brazil, Taiwan, and Chile. A study in Chile comparing women receiving private care (cesarean rate >40%) to women receiving public care (cesarean rate <20%) found that 8% of those receiving private care and 11% of those receiving public care stated a preference for cesarean delivery, with the vast majority preferring to deliver vaginally.15 Thus, even in this setting, it is unclear that maternal preferences are driving the increase in cesarean delivery rate."

Full article can be read here:


New Evidence: Give Women More Time in Labor.

Abby BlockComment

This one is so simple, so straight forward. Give women a bit more time to labor and we can reduce the cesarean rate. This is of course assuming that everything points to the mother and the baby being in good health. As long as everyone is doing find, and the mother is game, let's create the space and be encouraging and supporting to women who want to labor just a bit longer and potentially avoid a c-section. This recent study showed that giving mothers just one more hour of time can cut the Cesarean rate in half. That's big. Here's the article you can read to learn more:

Flipping A Breech Baby

Abby BlockComment

It happens! Babies are breeched and babies flip to the head down position. Occasionally they stay in the breech position. Ideally, baby flips! If your baby is in the breech position and you need to get them to flip, these are my recommended resources:

Spinning Babies: Breech Babies - very informational and detailed - recommend reading it all the way through

Prenatal Chiropractic Visits - ask me for a recommendation, based on where you are

Acupuncture - ask me for a recommendation, based on where you are

Good luck!!

US C-Sections Rate: Too High

Abby BlockComment

If you've been or are pregnant in NYC,  probably one of the first things you did was to figure out who your doctor would be and where you would give birth. You may have spent hours googling something like "NYC OB low cesarean rate," or "NYC hospital low c-section rate." And you may or may not have found the answers you were looking for. Consumer Reports just released an article reviewing the current state of cesarean births and rates by hospitals around the country. Many of the hospitals in NYC that my clients have given birth in do not release their statistics. Considering that your biggest Cesarean risk might be the hospital that you give birth in, withholding c-section rates by hospital (and even by practice or doctor) just doesn't seem ethical.

You can read the full article here:

The Forgotten Art of Untucking The Tail

Abby BlockComment

Very interesting as it relates to birthing a human...

“Modern birthing science has placed a large burden on secreted hormones (like relaxin) to prepare the body for needed mobility.” Katy Bowman says. Yes, hormonal relaxin is useful in letting the body open up for the birth, but it’s not enough, unless we have strong muscles that can fully contract, but also fully release. But then, strong isolated muscles are not enough either. In order to have smooth births we need to have a whole-body endurance. A great way to develop endurance is to walk as much as you can. “The woman who wants to go about a birthing process naturally can follow the lead other “natural” processes women have been doing for millennia — walking 5–6 total miles per day, and squatting to bathroom multiple times daily” — she adds.

Read the full article here.


Using a Mother’s Microbes to Protect Cesarean Babies

Abby BlockComment

"The first germs to colonize a newborn delivered vaginally come almost exclusively from its mother. But the first to reach an infant born by cesarean section come mostly from the environment — particularly bacteria from inaccessible or less-scrubbed areas like lamps and walls, and skin cells from everyone else in the delivery room.

That difference, some experts believe, could influence a child’s lifelong health. Now, in the first study of its kind, researchers on Monday confirmed that a mother’s beneficial microbes can be transferred, at least partially, from her vagina to her baby after a C-section."

Read the full article from the NYT Well Blog here.

Evidence Based Care for Pregnant Women

Abby BlockComment

Ever wonder what evidence-based care is? This great free video series by Rebecca Dekker, PhD of Evidence Based Birth does an excellent job of explaining what evidence-based care is and how to get it. A must watch video series for expecting parents - even if you are not pregnant yet! In fact, the sooner parents-to-be have access to this kind of information, the better. Whether you are interested in a natural birth, home birth, hospital birth, cesarean birth, birth with a doula, or birth without a doula, midwifery care or medical care model, this video series is for you! There's also a great video on the evidence for birth plans. Very enlightening. Enjoy!

Click here to watch the Evidence Based Birth video series: Do Birth Plans Really Work?

Avoiding the costs and risks of Cesareans

Abby BlockComment

One of the big reasons I get hired by my clients is because they want to avoid a c-section. In the U.S., our national c-section rate is about 33%, just over more than twice that of the rate recommended by the World Health Organization, which is 15%. Why are they performed so often then? Many people believe it's motivated financially, which it may be in some cases, but for most, it may be more motivated by the risk tolerance of a woman's OB. 

Read more here:

A Better Article for the Public About Doulas

Abby BlockComment

Recently, on my Facebook feed, there have been a bunch of articles circulating about doulas. Most of them accurately describe the general benefits and the research that proves we are a positive influence on a woman's birth experience and outcome. But then the articles often take funny twists and spiral down an odd road, describing the downsides of a doula, or scenarios which completely misrepresent the doula industry. (Most commonly the bring up doulas who don't support epidurals. I know a lot of doulas in NYC, and every single one of them, including me, supports a mother's choice to use an epidural in labor.) What if all articles about OGYNs or midwives or dentists, or geez, babysitters did the same thing and focused on a misperception that is uncommon in their industry? In any case, here's an article, for once, that doesn't seem to do that. Hurray!

Read the lovely article here: Doulas, What They Do and Don't Do, by Amelia Pang. Excerpt below.

"A doula is a non-medical professional who is certified to give physical comfort and emotional support to a woman before, during, and after delivery. Doulas can provide essential information about birth, and are on call 24-hours a day.

Although studies show doulas can greatly improve birth outcomes, not many women in the United States hire doulas.

According to the Second National U.S. Survey of Women’s Childbearing Experiences taken in 2006, only 3 percent of women said they used a doula during childbirth.

This is partly because there are some misconceptions about what doulas are and what kinds of services they provide."

Doula Support Could Improve Health Care & Reduce Costs

Abby BlockComment

Well, this one kind of seems like a no-brainer and no big surprise, but read the story on NPR if you need more of a reason to get a doula! An excerpt is below:

" Previous research has shown lower rates of cesarean births, more satisfaction from mothers and better newborn Apgar scores — a measure of a baby's condition at birth — among mothers who use doula care. In fact, the American Congress of Obstetricians and Gynecologists says in guidelines for safe prevention of cesarean births that doula care is "probably underutilized."

This is the first study, however, to show a reduction in preterm births and a net savings for public insurance. Cesarean births — about a third of all U.S. births — cost about twice as much as vaginal births, and the 1 in 10 U.S. infants born preterm (before 37 weeks) incur medical costs 10 times greater than those of full-term infants."