Did you know C-section rates in South Florida are some of the highest in the United States? In Miami-Dade County specifically, almost 50 percent of parents experience surgical births.

But what's an acceptable C-section rate? The World Health Organization (WHO) recommends that the average should be 10-15 percent. However, the most recent data from the CDC shows that the average C-section rate in the U.S. is about 32 percent. Either way, you look at it, the number of surgical births in Miami is high.

Given these numbers, we think it’s really important, along with our sister company The Gathering Place, to educate pregnant people about their birthing options. So, we’ve put together a list of 7 ways to avoid a C-section in Miami.

Wait for Labor to Begin Spontaneously

“Term” is considered by the WHO to be 42 weeks. The American College of Obstetricians and Gynecologists (ACOG) has issued strict guidelines on the practice of induction: It now recommends that practitioners wait until at least 39 weeks whenever possible and induce only when the benefits of delivery outweigh the risks.

Understanding the risk of going past 40 or 41 weeks is challenging, mostly because so many pregnant people don't actually get this far. Lots of birthing parents feel enormous pressure once the conversations about risk have begun, and not surprisingly, agree to induction even before they reach 42 weeks.

Why not just schedule the induction? First, your due date might not be as accurate as you think. What are the risks of induction other than preterm birth? The most common method of induction with the drug Pitocin, a synthetic version of the naturally occurring hormone oxytocin that causes the uterus to contract, can lead to a host of complications. These include more painful contractions (requiring additional medication), the baby’s poor reaction to the drug, and a significantly increased risk of C-section.

Does an induction always cause problems? No! And sometimes it is medically necessary, helpful, and even life-saving. But there are enough unnecessary risks to be wary.

Hire a Miami Doula

⁠A doula is someone who assists a birthing person during labor and provides support to them, the infant, and the family after childbirth. Historically, the responsibility of a “doula” was that of sisters, mothers, and aunties — those who were part of the community and experienced the journey of pregnancy, birth, and baby care. The Gathering Place continues that tradition by offering birth doula services.

What exactly does a doula do and how does having a doula help you avoid a C-section in Miami? Doula support results mean you have someone on your side who is knowledgeable about South Florida providers and birthing facilities — someone who can help you articulate your birth preferences and teach you and your partner how to advocate.

Those who hire a doula have less intervention during labor and birth, greater satisfaction with the birth experience, higher breastfeeding rates, and better postpartum adjustment. Doulas also help ensure you have the best opportunity to have the type of birth you want.

Through The Gathering Place, we’ve made sure all of our Magnolia clients have access to affordable doula support. We believe doulas are an integral part of the birth team, not an extra person in the room, and they perfectly complement the clinical care our Miami midwives provide.

Refuse Late-Term Ultrasounds

Ultrasounds near the end of pregnancy can result in unwarranted scrutiny of the fetal weight, leading to a higher chance of a C-section.

According to Evidence Based Birth (EBB), big babies are born to only 1 out of 10 parents. However, 2013 Listening to Mothers Survey found that 2 out of 3 American women had an ultrasound at the end of pregnancy to determine the baby’s size, and 1 out of 3 were told that their babies were too big. When their babies were born, the average weight of the suspected “big babies” was only 7 pounds, 13 ounces. Of the parents who were told that their baby was getting big, 2 out of 3 said their care provider discussed inducing labor because of the suspected big baby, and 1 out of 3 said their care provider talked about planning a C-section because of the big baby.

Most of the parents whose care providers brought up induction for a big baby were induced (67%), and the rest tried to self-induce labor (37%). Nearly 1 in 5 said they were not given a choice when it came to induction.

When care providers brought up planning a C-section for a suspected big baby, 1 in 3 pregnant people had surgical births. Two out of 5 said that the conversation went on as though C-section was the only option.

In the U.S., many pregnant folks have an ultrasound at the end of pregnancy to estimate the baby’s size, and if the baby appears large, their care provider will usually recommend either induction or elective C-section. Is this approach evidence-based? No.

Request Intermittent Fetal Heart Rate Monitoring

During labor, birthing parents who have continuous electronic fetal monitoring (EFM) are at an increased risk of having a C-section. In fact, one Cochrane review, as described by EBB, found that people who had continuous EFM were 65 percent more likely to have a Cesarean.

At most hospitals, providers use continuous EFM without differentiating between low- and high-risk patients. That means, even if you’re low-risk, the baby’s heart rate and your contractions will be monitored with sensors for the entire time you’re in labor. The sensors are linked to a machine that shows a print-out or computer screen of both the baby’s heart rate and your contractions. This method reveals the baseline fetal heart rate and how it reacts to contractions.

In the United States, “non-reassuring fetal heart tones” is the second most common reason for first-time Cesareans. (“Failure to progress” is first.) However, this language is vague, and abnormal heart patterns need to have standard definitions. There are ways to treat them before deciding to perform a C-section.

Interestingly, continuous EFM became standard in the 1970s without any research to show that it was safe and effective. Evidence does support what we call “hands-on listening,” a method of recording fetal heart tones at regular intervals, about every 15-30 minutes. In out-of-hospital birth settings like Magnolia, this intermittent fetal monitoring is done with a handheld Doppler.

According to ACOG, hands-on listening is an “appropriate and safe alternative” to continuous EFM for birthing people without known complications. If you plan to birth at a hospital, talk to your provider before you go into labor about intermittent fetal monitoring. Let your care team know your preference for hands-on listening, an evidence-based option for low-risk birthing parents.

Consider a Midwife, Birth Center, or Home Birth

If more pregnant people delivered their babies at midwife-led birth centers like Magnolia, the nation’s C-section rate would go down. Cost savings would also go up, reversing the current twin trend of rising healthcare expenditures and numbers of Cesarean deliveries.

That’s the conclusion reached in a study conducted by the American Association of Birth Centers and published in the Journal of Midwifery & Women’s Health. Researchers tracked 15,574 births and found that birth centers saved the healthcare system $30 million in facility fees alone. Birthing parents who deliver vaginally avoid the cost of surgery and the extra time in the hospital spent recovering.

Data from 2019 (the most recent figures available) show that less than 1 percent of U.S. women have their babies at birth centers, in contrast to other countries where midwife deliveries are far more common. It’s worth noting that birth centers only attend births for those with normal pregnancies and few complications.

About 85 percent of folks enter pregnancy classified as low-risk, which means they have no serious medical conditions. In the country’s nearly 400 birth centers, midwives tend to take far more time with patients than busy doctors do. The emphasis is on the whole person — everything from consultations on healthy eating during pregnancy to conversations about anxiety over delivery.

The midwife wellness-based model of care is why birth centers have such great outcomes and why we are so proud to serve families at Magnolia, where you can choose to give birth at our center or at your home.

Search for Statistics

Before you choose a provider and a birthing facility, seek out information on their C-section, labor induction, and labor augmentation rates. Then, choose a provider with low rates. ⁠ When you select a reproductive provider and facility with low rates, it increases your likelihood of a vaginal birth. ⁠

How can you find this information? You can start by asking your provider for their rates or the practice’s rates. Most keep track of their data, but some are more open to sharing than others. If they decline to share, you can search the facility’s website. Again, some publish this information publicly, while others do not.

Other sources for finding these numbers and statistics include the CDC website and the Joint Commission through its website, Quality Check. You can search by area or by the name of the healthcare facility.

Take an Independent Childbirth Class

Being informed is one of the best ways to avoid a C-section in Miami. That’s why it’s important to take a childbirth education class. While you’re still pregnant, you’ll learn about what to expect during labor and common decisions to be made throughout the birth process.

Some of the typical birth protocols, such as continuous fetal monitoring, restricted movement, and lack of food and drink, can lead directly to those dreaded phrases like “failure to progress” and “non-reassuring fetal heart tones.” These scenarios often have a significant effect on birth outcomes, including the increased likelihood of a C-section.

When you participate in childbirth classes, you’ll be able to approach birth with knowledge and confidence. At The Gathering Place, our preparation courses emphasize childbirth as a normal, healthy, and uniquely personal event in the life of a family.

Do you want to learn more about avoiding a C-section in Miami by having an informed, empowered experience at Magnolia? Schedule a free consultation by filling out our form!