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Cesarean Awareness Month has been an important opportunity to raise awareness about the high cesarean section rate in the United States and what can be done to reduce unnecessary cesareans, including strong partnerships among the nation’s leading maternity care provider organizations to achieve this goal. As the month comes to a close, we offer a few reminders about this procedure that pregnant women, advocates and health care providers should keep in mind all year long.

Where and with whom a woman gives birth plays a large role in determining her likelihood of experiencing cesarean birth.

There are very large and unwarranted variations in cesarean rates across hospitals, maternity care providers and states. To avoid a medically unnecessary cesarean, women can seek out maternity care providers and birth settings with lower cesarean rates – hospital-level cesarean rates in low-risk women are available here. In addition, all women should talk with their maternity care providers early in pregnancy about when and why they recommend cesareans and learn more about when this procedure is likely to be the best course of action. Tip: It’s important to know that a fetus that might be getting large is almost never a good reason to plan a cesarean birth.

Women and care providers can take steps to reduce the risk of cesarean birth.

High-quality research has shown that the following practices before and during labor reduce the likelihood of having a cesarean:

• Regular low to moderate physical activity, especially in the second and third trimesters.
• Planning to give birth in a birth center.
• If you had a cesarean in the past, finding a midwife or doctor and hospital that are supportive of vaginal birth after cesarean (VBAC).
• If a baby is breech (buttocks- or feet-first) at the end of pregnancy, having a health care provider use hands-to-belly movements (external version) to help turn the baby to a head-first position.
• Waiting to go to the hospital until “active labor” begins (women should stay in touch with a care provider in early labor for advice about identifying the beginning of active labor and going to the hospital).
• Receiving continuous support during labor from a doula. (Find a doula at www.DONA.org.)
• Staying upright and moving about during labor rather than lying down in bed.
• Monitoring the baby’s heart rate during labor periodically with a handheld device (such as a Doppler) rather using continuous electronic fetal monitoring (EFM).
• Being patient (and staying relaxed and conserving energy) during labor, and recognizing that length of labor varies from woman to woman and birth to birth.

Let’s keep the momentum from Cesarean Awareness Month going year-round by sharing resources and advocating for policies and practices that give women who need it access to cesarean while reducing the rate of unnecessary cesarean birth. To learn more about cesarean birth, visit www.ChildbirthConnection.org/cesarean.