What may affect your chances of needing a caesarean section?

Predicting if you will need a caesarean section

You should not be offered X-rays of your pelvis, or vaginal examinations to measure the size of your pelvic bones, because they do not help to predict the course of your labour. For the same reason, your healthcare team do not need to take any account of your height, the size of your feet or the size of your baby in trying to predict the course of your labour.

If you have a body mass index of over 50, your healthcare team should not use this alone when deciding if you will need a caesarean section.

Reducing your chances of needing a caesarean section

Some things are known to reduce the chances of a caesarean section, although they may also affect other aspects of your labour or the birth that are not considered in the NICE guideline. These include:

  • Having another woman with you for support throughout your labour.

  • Being offered induction of labour after 41¬†weeks of pregnancy. This is safer for the baby.

  • Using a chart called a partogram to follow the progress of your labour. At intervals, your midwife or doctor will offer you a vaginal examination to measure how far your cervix has opened up (dilated), and feel your abdomen to see how the baby is moving downwards. If the progress of your labour is more than 4¬†hours behind the average they should discuss with you what your options are (including whether you can go ahead with a vaginal birth), and take action as appropriate.

  • Involving a consultant (senior) obstetrician in decision-making about caesarean section.

  • In some cases, the midwife or doctor will need to monitor the baby's heartbeat and contractions throughout labour, using electronic devices attached to your abdomen. This is called cardiotocography, or CTG for short. If the doctor or midwife suspects your baby is not coping well with labour, further action may be offered. This could include immediate caesarean section, but usually a blood sample from the baby is taken before the decision is made. This is done by passing a small tube through a speculum to take the blood sample from a pinprick on the baby's scalp. This sample will be tested to see if the baby is coping well with labour. Having this test may avoid an unnecessary caesarean section.

Things that do not affect your chances of needing a caesarean section

Some things make no difference to the chances of a caesarean section, although they may affect other aspects of your labour or the birth that are not considered in the NICE guideline. These include:

  • walking around while you are in labour

  • not lying on your back in the second stage of labour

  • being in water during your labour

  • having epidural pain relief during labour

  • taking raspberry leaves

  • early breaking of the waters (amniotomy)

  • active management during labour (a type of care that includes one-to-one support from a midwife, early breaking of the waters, and the early use of the drug oxytocin to encourage the womb to contract).

Further research is needed on whether using complementary therapies (such as acupuncture, aromatherapy, hypnosis, herbal products, nutritional supplements or homeopathic medicines) during labour reduces the chance of having a caesarean section.

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