Due to the continued lack of access for a trial of labor after cesarean (TOLAC), people who birth after a surgical birth often have a planned repeat cesarean.  This makes it even more critical to prevent the primary cesarean.  Mortality and morbidity risks, especially for the parent, increase with every cesarean that a person undergoes.

Many people taking childbirth classes may not want to think about the possibility of having a cesarean, planned or unplanned. “I didn’t even read that section of the book, because I didn’t want to think about that,” is a common statement that I often hear from students.  The likelihood that they will birth by cesarean is real. You can help families  who attend your classes reduce the chances of birthing by cesarean.  Make sure your class learning objectives include the following:

• Helping them to identify an appropriate provider and birth facility based on their health status and birth intentions.
• Facilitating confidence in their own ability to navigate informed consent and refusal/declination conversations with care providers
• Encouraging adding a birth doula on their team, to offer support, information and assistance with coping and comfort measures.
• Preparing families for the possibility of a surgical birth, and how to make that positive and include evidence based actions in the operating room.
• Sharing cesarean and VBAC resources and support groups for those who birth by cesarean, so they can receive continued peer-to-peer support and information after the birth and in the future.

Here are some activities that you can do in your birth classes that helps increase parents’ ability to prepare as best they can.

• Series – Brilliant Activities for Birth Educators: Cesarean Sort
• Series: Brilliant Activities for Birth Educators – Cesarean Pie
• Series: Brilliant Activities for Birth Educators- Cesarean Birth Preferences
• Series: Brilliant Activities for Birth Educators - Cesarean Section Role Play Helps Prepare Families
• Series: Brilliant Activities for Birth Educators - Virtual Backgrounds to Teach about Cesareans (or Really Anything!)

While April is Cesarean Awareness Month - the topic should be one that is routinely and thoroughly covered in each and every class throughout the year, so that parents have the opportunity to be prepared and informed to avoid giving birth by cesarean when there is not a medical need.

International Cesarean Awareness Network has resources for CAM2021 that you can find here.

References

Boerma, T, Ronsmans, C, Melesse, DY, Barros, AJD, Barros, FC, Juan, L, et al.. Global epidemiology of use of and disparities in caesarean sections. Lancet 2018;392:1341–48. https://doi.org/10.1016/s0140-6736(18)31928-7.

Wiklund, I, Malata, AM, Cheung, NF, Cadee, F. Appropriate use of caesarean section globally requires a different approach. Lancet 2018;392:1288–89. https://doi.org/10.1016/s0140-6736(18)32325-0