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Cesarean Section

What is a cesarean section?
A cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward. See a picture of a delivery by C-section.

If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it’s a good idea to learn about C-section, in case the unexpected happens.

When is a C-section needed?
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. Reasons you might need an unplanned C-section include:
* Labor is slow and hard or stops completely.
* The baby shows signs of distress, such as a very fast or slow heart rate.
* A problem with the placenta or umbilical cord puts the baby at risk.
* The baby is too big to be delivered vaginally.

When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:
* The baby is not in a head-down position close to your due date.
* You have a problem such as heart disease that could be made worse by the stress of labor.
* You have an infection that you could pass to the baby during a vaginal birth.
* You are carrying more than one baby (multiple pregnancy).
* You had a C-section before, and you have the same problems this time or your doctor thinks labor might cause your scar to tear (uterine rupture).

In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean (VBAC). If you have had a previous C-section, ask your doctor if VBAC might be an option this time.

In the past 40 years, the rate of cesarean deliveries has jumped from about 1 out of 20 births to about 1 out of 4 births.1 This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.

What are the risks of C-section?
Most mothers and babies do well after C-section. But it is major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:
* Infection of the incision or the uterus.
* Heavy blood loss.
* Blood clots in the mother’s legs.
* Injury to the mother or baby.
* Problems from the anesthesia, such as nausea, vomiting, and severe headache.
* Breathing problems in the baby if it was delivered before its due date.
If she gets pregnant again, a woman with a C-section scar has a small risk of the scar tearing open during labor (uterine rupture). She also has a slightly higher risk of a problem with the placenta, such as placenta previa.

How is a C-section done?
Before a C-section, a needle called an IV is put in one of the mother's veins to give fluids and medicine (if needed) during the surgery. She will then get medicine (either epidural or spinal anesthesia) to numb her belly and legs. Fast-acting general anesthesia, which makes the mother sleep during the surgery, is only used in an emergency.

Once the anesthesia is working, the doctor makes the incision. Usually it is made low across the belly, just above the pubic hair line. This may be called a "bikini cut." Sometimes the incision is made from the navel down to the pubic area. See a picture of C-section incisions. After lifting the baby out, the doctor removes the placenta and closes the incision with stitches.

How long does it take to recover from a C-section?
Most women go home 3 to 5 days after a C-section, but it may take 4 weeks or longer to fully recover. By contrast, women who deliver vaginally usually go home in a day or two and are back to their normal activities in 1 to 2 weeks.

Before you go home, a nurse will tell you how to care for the incision, what to expect during recovery, and when to call the doctor. In general, if you have a C-section:

* You will need to take it easy while the incision heals. Avoid heavy lifting, intense exercise, and sit-ups. Ask family members or friends for help with housework, cooking, and shopping.

* You will have pain in your lower belly and may need pain medicine for 1 to 2 weeks.

* You can expect some vaginal bleeding for several weeks. (Use sanitary pads, not tampons.)

Call your doctor if you have any problems or signs of infection, such as a fever or red streaks or pus from your incision.

Caesarean delivery — also known as a C-section — is a surgical procedure used to deliver your baby through an incision in your abdomen. Some C-sections are planned due to pregnancy complications or because you've had a previous C-section. But, in many cases, the need for a first-time C-section doesn't become obvious until labor has already started. Knowing what to expect during the procedure and recovery can help you prepare.

Sometimes a C-section is safer for you or your baby than is a vaginal delivery. Your doctor may recommend a C-section if:

* Your labor isn't progressing. Stalled labor is the most common reason for a C-section. Perhaps your cervix isn't opening enough despite strong contractions over several hours. Or the baby's head may simply be too big to pass through your birth canal.

* Your baby's heartbeat suggests reduced oxygen supply. If your baby isn't getting enough oxygen or your doctor is concerned about changes in your baby's heartbeat, he or she may recommend a prompt C-section.

* Your baby is in an abnormal position. A baby whose feet or buttocks enter the birth canal before the head is in the breech position. If your doctor isn't able to move the baby into a more favorable position before labor begins, you may need a C-section to reduce the risk of complications. A C-section is also needed if your baby is lying horizontally across your uterus.

* Your baby's head is in the wrong position. If your baby enters the birth canal chin up or with the top of the forehead or face leading the way, he or she may not fit through your pelvis. A C-section may be the safer way to deliver the baby.

* You're carrying twins, triplets or other multiples. When you're carrying multiple babies, it's common for one or more of the babies to be in an abnormal position. In this case, Caesarean birth is often safer — especially for the second baby.

* There's a problem with your placenta. If the placenta detaches from your uterus before labor begins (placental abruption) or the placenta covers the opening of your cervix (placenta previa), C-section is often the safer option.

* There's a problem with the umbilical cord. A C-section may be recommended if a loop of umbilical cord slips through your cervix ahead of your baby or if the cord is compressed by the uterus during contractions.

* Your baby is very large. Some babies are simply too big to safely deliver vaginally. Typically this is only a factor if you have diabetes.

* You have a health problem. If you have a condition such as diabetes, heart disease or lung disease, your doctor may induce labor early to reduce the risk of pregnancy-related complications. If the induction isn't successful, you may need a C-section.

In other circumstances, a C-section may be recommended if you have an active genital herpes infection or another condition that your baby might acquire while passing through the birth canal.

* Your baby has a health problem. A C-section may be safer for babies with certain developmental problems, such as failure of the spine to close properly (spina bifida) or excess fluid in the brain (hydrocephalus).

* You've had a previous C-section. Depending on the type of incision and other factors, you may be able to attempt a vaginal delivery after a previous C-section. In some cases, however, your doctor may recommend a repeat C-section.

Risks

Recovery from a C-section takes longer than does recovery from a vaginal birth. And like other types of major surgery, C-sections also carry a higher risk of complications.

Risks to your baby include:

* Breathing problems. Babies born by C-section are more likely to develop a breathing problem marked by abnormally fast breathing during the first few days after birth (transient tachypnea).

* Fetal injury. Although rare, accidental nicks to the baby's skin can occur during surgery.

Risks to you include:

* Inflammation and infection of the membrane lining the uterus. This condition — known as endometritis — may cause fever, chills, back pain, foul-smelling vaginal discharge and uterine pain. It's often treated with intravenous (IV) antibiotics.

* Increased bleeding. You may lose more blood with a C-section than with a vaginal birth. However, blood transfusions are rarely needed.

* Urinary tract infection. You may develop a urinary tract infection in the bladder or kidneys.

* Decreased bowel function. Any abdominal surgery slows the movement of waste material through your intestines. Some medications for pain relief may further contribute to this problem, leading to constipation.

* Reactions to anesthesia. After regional anesthesia, a small number of women may experience a headache caused by a leak of the fluid around the spinal canal into the tissues of the back. Allergic or adverse reactions to the anesthetic also are possible.

* Blood clots. The risk of developing a blood clot inside a vein — especially in the legs or pelvic organs — is about four times greater after a C-section than after a vaginal delivery. If a blood clot travels to your lungs (pulmonary embolism), the damage can be life-threatening. Your doctors will take steps to prevent blood clots. You can help, too, by walking frequently soon after surgery.

* Wound infection. An infection at or around the incision site is possible. When a wound is infected, it may open at the skin and release pus.

* Additional surgeries. Although rare, surgical injuries to nearby organs can occur during a C-section. If this happens, additional operations may be needed.

* Increased risks during future pregnancies. After a C-section, you face a higher risk of potentially serious complications — including bleeding, placenta previa, abnormal fetal positions and tearing of the uterus along the scar line from the prior C-section (uterine rupture) — in a subsequent pregnancy than you would after a vaginal

How you prepare

If your C-section is scheduled in advance, your doctor may suggest you talk with an anesthesiologist to discuss your questions about anesthesia and options for pain relief during delivery.

Your doctor may also recommend you have blood tests before your C-section. This is so that information about your blood type and your levels of hemoglobin — the iron-rich protein in red blood cells that gives blood its red color — are available to your health care team during the procedure. This information can be helpful to your medical team in the unlikely event that you need a blood transfusion.

After a C-section, you'll need several weeks to rest and recover. So, before your C-section, consider requesting help at home for the weeks following the birth of your baby. This may include arranging for extra child care if you have older children.

Preparing for the unexpected

Getting the unexpected news that you need a C-section can be stressful, both for you and your partner. And in an emergency, your doctor may not have time to explain the procedure and answer your questions. So, discuss the possibility of a C-section with your doctor well before your due date. Ask questions, share your concerns and review the circumstances that might make a C-section the best option.

Illustration of abdominal incisions used during C-sections
Abdominal incisions used during C-sections
Illustration of uterine incisions used during C-sections
Uterine incisions used during C-sections

During the procedure

An average C-section takes about 45 minutes to one hour. In most cases, your spouse or partner can stay with you in the operating room during the procedure.

* Preparation. Before the C-section, a member of your health care team cleanses your abdomen. A tube (catheter) may be placed into your bladder to collect urine. IV lines are placed in a vein in your hand or arm to provide fluid and medication. A member of your health care team may also give you an antacid to reduce your risk of an upset stomach during the procedure. *

Anesthesia. Regional anesthesia — one which numbs only the lower part of your body — is most often used during C-sections. One type of regional anesthesia that can be used is a spinal block. With a spinal block, the medication is injected directly into the sac surrounding your spinal cord. Another type of regional anesthesia used during C-sections is epidural anesthesia. With epidural anesthesia, pain medication is injected into your lower back just outside the sac that surrounds your spinal cord.

If there's a need to start the procedure quickly, a spinal block is often used because it takes effect faster than epidural anesthesia.

If you receive a regional anesthesia, you'll be awake during the procedure and will be able to hear and see the baby right after delivery.

In an emergency, you may need general anesthesia. This type of anesthesia is usually started with medication delivered through an IV line in your arm, but sometimes it can be started with a gas that you breathe from a mask. With general anesthesia, you won't be able to see, feel or hear anything during the birth.

* Abdominal incision. Your doctor makes an incision through your abdominal wall. It's usually done horizontally near the pubic hairline (bikini incision). If a large incision is needed or your baby must be delivered very quickly, your doctor may make a vertical incision from just below the navel to just above the pubic bone.

* Uterine incision. After the abdominal incision, your doctor makes an incision in your uterus. The uterine incision is usually horizontal across the lower portion of the uterus (low transverse incision). Other types of uterine incisions may be used depending on your baby's position within your uterus and whether you have complications, such as placenta previa.

* Delivery. If you have epidural or spinal anesthesia, you'll likely feel some movement as the doctor gently removes your baby from your uterus — but you won't feel pain. The doctor clears your baby's mouth and nose of fluids, and clamps and cuts the umbilical cord. The placenta is removed from your uterus, and the incisions are closed with stitches.

Although you may not be able to hold your baby immediately, you'll likely be able to see your baby right away.

After the procedure

* In the hospital. After a C-section, most mothers and babies stay in the hospital for about three days. To control pain as the anesthesia wears off, you may use a pump that allows you to adjust the dose of IV pain medication.

Within the first 24 hours after your C-section, you'll be encouraged to get up and walk. Moving around can speed your recovery and help prevent constipation and potentially dangerous blood clots. The catheter and IVs will likely be removed within 12 to 24 hours of the C-section.

While you're in the hospital, your health care team will monitor your incision for signs of infection. They'll also monitor your appetite, how much fluid you're drinking, and bladder and bowel function.

Before you leave the hospital, talk with your doctor about any preventive care you may need, including vaccinations. It's a good time to make sure your immunizations are up to date to help protect your health and the health of your baby.

* Breast-feeding. IVs and discomfort near the C-section incision can make breast-feeding somewhat awkward. With help, however, you'll be able to start breast-feeding soon after the C-section. Ask your nurse or the hospital's lactation consultant to teach you how to position yourself and support your baby so that you're comfortable.

Trying to breast-feed when you're in pain may only make the process more difficult. Your health care team will select medications for your post-surgical pain with breast-feeding in mind. Continuing to take the medication shouldn't interfere with breast-feeding.

When you go home

It takes about four to six weeks for a C-section incision to heal. Fatigue and discomfort are common. While you're recovering:

* Take it easy. Give yourself time to rest. Keep everything that you and your baby might need within reach. For the first two weeks, don't lift anything heavier than your baby.

* Support your abdomen. Use good posture when you stand and walk. Hold your abdomen near the incision during sudden movements, such as coughing, sneezing or laughing. Use pillows or rolled up towels for extra support while breast-feeding.

* Drink plenty of fluids. Drinking lots of fluids can help replace those lost during delivery and breast-feeding, as well as prevent constipation. Remember to empty your bladder frequently to reduce the risk of urinary tract infections.

* Avoid sex. Many doctors recommend waiting six weeks before resuming intercourse. But don't give up on intimacy. Spend time with your partner, even if it's just a few minutes in the morning or after the baby goes to sleep at night.

* Take medication as needed. Your doctor may recommend acetaminophen (Tylenol, others) to relieve pain. If you're constipated or bowel movements are painful, your doctor may recommend an over-the-counter stool softener or a mild laxative, such as milk of magnesia.

* Know when to contact your doctor. Promptly report any signs of infection to your doctor. These include a fever over 100.4 F (38 C); severe pain in your abdomen; redness, swelling and discharge at your incision site; or flu-like symptoms accompanied by pain in one or both breasts.

Contact your doctor if you develop a rash or hives; foul-smelling vaginal discharge; burning with urination; blood in your urine; extremely heavy bleeding that soaks a maxi pad within one hour or passing large clots; or swollen, red or painful areas in your legs.

Postpartum depression may be a concern as well. If your mood is consistently low, you find little joy in life or you have trouble summoning the energy to start a new day, seek help promptly.

If you're disappointed that you had a C-section rather than a vaginal birth, remind yourself that your health and your baby's health are more important than the method of delivery. Although it takes longer to recover from a C-section than from a vaginal birth, the end result is the same — and the adventure of caring for your baby is likely to overshadow it all.

Why would I want to avoid a cesarean?
Cesarean section increase many of the risks to mothers and babies. When this risk is weighed against other circumstances, it can be the better choice, however, sometimes it is a choice of convenience, or a matter of lack of information.

Here are some places to check out for help with avoiding an UNNECESSARY cesarean:

* Avoiding unnecessary Cesareans

Indications for a Cesarean

What are some reasons that would mean I would need a cesarean?
Prolapsed cord (where the cord comes down before the baby), placenta abruptio (where the placenta separates before the birth), placenta previa (where the placenta partially or completely covers the cervix), fetal malpresentation (transverse lie, breech (breech can sometimes be managed by External Version, exercises or a vaginal breech birth), or asynclitic position), cephalopelvic disproportion (CPD, meaning that the head is too large to fit through the pelvis. This can also be over diagnosed, it can be caused by maternal positioning either from restraint to bed, lack of mobility or anesthetics.), maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc. (please note that these conditions do not ALWAYS mean a cesarean.)), fetal distress (This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes. Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.), maternal exhaustion, and repeat cesarean, these are the main reasons for cesareans.

Pain Relief During and After the Cesarean

What type of pain relief is offered before and after a cesarean?
If you have not already had a epidural or spinal anesthesia for labor, or this is a scheduled cesarean, and not an emergency cesarean, you will most likely be given a regional anesthetic (epidural or spinal). If there is a reason that you can't get regional anesthesia or it is an emergency you will be given a general anesthetic. You may be offered or want to watch for someone giving you a pre-operative sedative. If you are not particularly nervous about the cesarean, you may want to forego this medication. It can reach the baby and make it harder to start the baby breathing after a narcotic (usually), and it can make you groggy an unaware during the birth. After the birth your regional anesthesia will help you be pain free for a few hours, after which you will be prescribed some other type of pain medication (narcotic or otherwise).

See also: Planning Your Cesarean FAQ for more discussion of options.

Note: Some people have noted that there are major discrepancies between epidural and epidural. The feelings can range from total loss of sensation to being able to feel parts of your body. However, with spinal anesthesia there is a more uniform total loss of sensation. When you have already had the epidural, generally a different medication will be added to the catheter and the dosage increased.

Procedures for Cesarean

What is the procedure for a cesarean?
Some of these may go in a different order, and a few left out, but these are the basics:

* A catheter inserted to collect urinev * An intravenous line inserted
* An antacid for your stomach acids
* Monitoring leads (heart monitor, blood pressure)
* Anesthesia
* Anti-bacterial wash of the abdomen, and partial shaving of the pubic hair
* Skin Incision (vertical or midline(most common))
* Uterine Incision
* Breaking the Bag of Waters
* Disengage the baby from the pelvis
* BIRTH!!!! (Accomplished by hand, forceps, or vacuum extractor)
* Cord Clamping and cutting
* Newborn Evaluation
* Placenta removed and the uterus repaired
* Skin Sutured (Usually the top layers will be stapled and removed within 2 weeks.)
* You will be moved to the Recovery Room (If the baby is able s/he can go with you.)

How long will it be until my baby is born?
It is generally 5 minutes from the time that they make the initial incision until the baby is born. The rest of the surgery will take between 30 and 40 minutes, including repair.

Cesarean Primer for Partners

As her partner, how can I help her during a cesarean?
Most hospitals will allow you to go into the operating room with your partner, or if you feel unable to, she may be accompanied by one other person (some hospitals will allow two if one is the doula). Contrary to popular belief, most people do not faint in the operating room. The mother will provided a drape to block her view of the surgery, feel free to stay behind the curtain with her if you are worried. Just being there for her and telling her what is going will help her. Sometimes the doctor will allow you to cut the cord, carrying the baby to the nursery, and take pictures. Make sure that you ask about these particular things.

"...be prepared to see you wife/partner treated with an apparent lack of dignity. I was taken away to be prepped and Dennis was left in the birthing center labor room. When they ushered him into the operating room I was spreadeagled on the table, buck naked, with betadine wash all over my belly. It looked to him like I'd been crucified. Plus there were all these people there, which generally would *not* be the case when I'm naked. To them it was just business, but to him it was his wife and baby." -Penny H.

Emergency Cesarean

What is an emergency Cesarean?
Basically, an emergency cesarean would be one that meant a matter of minutes was all that remained before the serious threat of loss of life or damage became imminent. Generally, this would be a placenta abruptio, a prolapsed cord, etc. General anesthesia is usually used, in combination with a vertical incision (for the matter of time), and your partner is generally not allowed to accompany you.

Recovery

What will my recovery be like?
Everyone's recovery will be different, depending on your age, body type, and general health. However, some basics of recovery will be to remember that you have just had major abdominal surgery as well as given birth to a new baby. You may be plagued with gas pains from being opened, incisional pain, uterine contractions (your uterus will still need to work to get back to it's original shape). You may be extremely tired from medications, labor (if you had one), or just in general. Your staples will usually be removed about 4-7 days postpartum. Try to take everything easy. Do as little as possible, although walking as soon as possible is very helpful in your recovery. The rule of thumb is to not lift anything heavier than your baby. When you get home, take the steps only once a day (if at all). Make a nest on the couch and nap there during the day. Get as much help as you can with your cleaning, food preparations, and other children.

You can start doing breathing exercises the first day in the hospital, someone will show you how. Then each day you can gradually find small exercises to do to get back into shape. Do not return to your previous exercise routine without permission of your care provider. Overdoing it will only slow your recovery.

By the end of six weeks, some people say they are feeling pretty good, although still dealing with some pain and sleeplessness. After this period you can usually resume most activities (Some doctors will allow you to drive after about 2 weeks, others request that you wait the entire 6.).

Read: After a Cesarean

"Do get up as soon as they'll let you, even though it hurts like hell the first time you get out of bed. Also, I found one of those big elastic belly supports really helpful when I got home. I didn't use it for long, but for those first few days, it really made laying on my side and rolling over in bed much less painful." -France W.

Breastfeeding after a Cesarean

Can I still breastfeed if I had a cesarean?

Certainly you can. It may take some more effort on your part, but do not hesitate to ask for help. Your hospital should have a lactation consultant on hand to help you get started. Start breastfeeding as soon as possible, for some this will be in the recovery room, for others you may have to pump for a sickly baby or to encourage your milk supply. There are different positions that will be helpful to you in breastfeeding after a cesarean, like the football hold, or any other position that keeps the baby off of your incision.

For more help try:

* Breastfeeding After a Cesarean FAQ

"My son Aaron was born via emergency C-section. I was under general anesthetic and was therefore unable to breastfeed "Immediately" after he was born. After I was out of recovery and allowed to hold him (3 hours later), the doctors told me to wait and not try to breastfeed him because of how tiring it would be on me, and I needed my rest, etc., etc. They suggested waiting until the next day to attempt the first feeding. I was so drugged up (morphine, demerol) that I didn't protest. However when I was a little more aware a few hours later, I insisted on having my baby and successfully breastfed him. So, my advice would be to breastfeed when you feel up to it, not when you doctor says you should or shouldn't. It's your baby and you choice." -Angie J.

Vaginal Birth After a Cesarean

I had one cesarean (or more!), will I have to have another cesarean?

Recent studies have shown that there was an over 80% success rate for VBACs. Finding a care provider who is supportive and being educated are still the keys to preventing an unnecessary cesarean, even if it is a repeat cesarean.

I had one cesarean (or more!), will I have to have another cesarean?

Recent studies have shown that there was an over 80% success rate for VBACs. Finding a care provider who is supportive and being educated are still the keys to preventing an unnecessary cesarean, even if it is a repeat cesarean.

One of the biggest fears of having a woman labor after having had a previous cesarean was the fear that her scar would tear. That is very unlikely, especially with the mid-line (bikini-cut) incisions that are the most popular today. Talk to your care provider about any fears you have and read books, talk to others who have experienced VBAC.

Where should I look for information?

Emotions and Feelings

What are some feelings that I may have after the cesarean?

Many people say that they feel a range of emotions. They can be happy that their baby is there safely, disappointed that they did not achieve their "dream" birth, mad at the circumstances or some people, disconnected from the baby, or just relieved to get it over with.

It is important to remember that all new mothers go through emotional changes as the baby is born. This can be from the hormones, the situation, etc. However, in mothers who also are recovering from a major surgery, these can be more pronounced.

* Episiotomy: Can you deliver a baby without one?
* Video: C-section — What to expect
The epidural block
* What is a birth plan and why do I need one?
* Even the best birth plans don't always work out
* Labor pain: Weigh your options for pain relief
* Signs of labor: Know what to expect
* Slide show: Exercises to prepare for labor
* Labor pain: Medications for labor and delivery
* Stages of labor: Baby, it's time!
* Inducing labor: Your questions answered
* Preterm labor: Prevention is key
* Childbirth education: Get ready for labor and delivery
* Slide show: Labor positions
* Slide show: Vaginal tears in childbirth
* Pregnancy and you blog
* Vaginal birth after C-section (VBAC) guide

A cesarean delivery may be necessary if one of the following complications is present:

* Your baby is not in the head-down position.
* Your baby is too large to pass through the pelvis.
* Your baby is in distress.

How would you describe your health status?
I am healthy and not currently suffering from any health conditions.

I am generally healthy but have a chronic, yet well-controlled, health condition like asthma, diabetes, thyroid disease, anemia or high blood pressure, or am over 35, have had a previous cesarean section, or previously used assisted reproductive technology.

I currently have a serious health condition like diagnosed heart disease, active cancer, or I have received an organ transplant.

Which statement best describes your situation?
My pregnancy is expected to be normal and healthy.

My pregnancy is at high risk for health problems, or my baby is at high risk for birth defects.

I'm not sure.

When thinking about your ideal conditions for giving birth, how closely do you agree with the following statements?
1. I want the freedom to move about in labor, including walking, rocking, standing, and walking to the bathroom.

Disagree
Somewhat Disagree
Somewhat Agree
Agree

2. I want the option of eating and drinking in labor.

Disagree
Somewhat Disagree
Somewhat Agree
Agree

3. During labor, I want to do my best to cope with the pain and/or discomfort through a variety of techniques, such as massage, taking a warm bath, or emotional support.

Disagree
Somewhat Disagree
Somewhat Agree
Agree

4. I want to avoid an episiotomy.

Disagree
Somewhat Disagree
Somewhat Agree
Agree

When thinking about your ideal conditions for giving birth, how closely do you agree with the following statements?

5. I want to avoid the use of forceps or vacuum in the delivery of my baby.

Disagree
Somewhat Disagree
Somewhat Agree
Agree

6. I want to know that epidural pain relief will be available to me in labor.
Disagree
Somewhat Disagree
Somewhat Agree
Agree

7. I want to avoid a cesarean section.
Disagree
Somewhat Disagree
Somewhat Agree
Agree

8. I want to avoid having my labor induced.
Disagree
Somewhat Disagree
Somewhat Agree
Agree

9. It is important to me to be able to schedule my baby’s birth rather than wait for labor to start on its own.
Disagree
Somewhat Disagree
Somewhat Agree
Agree

10. I would like to hold my baby immediately after s/he is born and don’t want to be separated from my baby in the hours after birth.
Disagree
Somewhat Disagree
Somewhat Agree
Agree

Which statement more closely reflects your feelings?
Childbirth is dangerous. It is important for a health care provider to actively manage and control the process so that nothing goes wrong.

Childbirth is a normal, natural process. Mothers should be supported and encouraged throughout this process by a health care provider who is also expertly trained to spot and address medical problems.

Which statement more closely reflects your feelings?
For my prenatal visits, I think shorter appointments will make me feel rushed and I would prefer longer appointments so I can take my time in asking questions and getting answers from my care provider.
For my prenatal visits, I don’t mind the idea of shorter appointments because I can get additional information from friends, family and the Internet.

Which statement more closely reflects your feelings?
I would rather leave most decisions about my health care to my provider.
I want a health care provider who will be my partner in working toward a healthy pregnancy and delivery and help me make informed decisions.

Which statement more closely reflects your feelings?
In labor, I want a health care provider who will be there to support and encourage me during my labor and birth.
In labor, I don’t expect my care provider to be by my side, unless I have a medical problem or the baby is ready to be born.

Which statement more closely reflects your feelings?
I prefer to have a health care provider who has a low rate of interventions like episiotomy, induction, and cesarean section.

I don’t mind if my health care provider has a high rate of interventions like episiotomy, induction, and cesarean section.