Few women go into childbirth wanting to have a cesarean section, or C-section -- an operation to remove the baby from the uterus. Recovery time is faster with a vaginal birth, and then, of course, there's no risk from major surgery. But for the past many years in the U.S., the rate of C-sections is close to 1 in 3. 

Now that rate is starting to come down, thanks in part to the increased involvement of midwives in U.S. births. One study found that having midwives involved in births lowered the C-section rate from 31.7 percent to 25.0 percent. As well, vaginal births after cesarean delivery (VBACs) increased when midwives were providing the most care during pregnancy and labor. But why do midwives make a difference?

Midwives don't view C-sections as an option.

It turns out that obstetricians and even some family physicians who learn how to perform C-sections and see them save lives in emergency situations might be more likely to want to perform the surgery, even if conditions don't absolutely require it. 

One study that compared the attitudes of midwives vs. obstetricians found that the doctors were more willing to perform a C-section even without indications that it was required and that they felt C-sections were a technological advance that improved birth outcomes. In comparison, most midwives felt the opposite.

Hospitals with operating rooms make C-sections more likely.

One alternative to a hospital is a birthing center, a medical clinic designed only for labor and vaginal delivery. Birthing centers have trained midwives and up-to-date equipment, but no operating rooms. Typically, these centers are located close to a hospital in case a woman must be transported for an emergency. 

Midwives who work in birthing centers report that they need to transfer to a hospital less than 2 percent of the time. The birthing centers are less expensive and have outcomes similar to those in hospitals for low-risk pregnancies. This indicates that many of the C-sections performed in hospitals were not medically necessary and could have been avoided if other options were pursued first.

Epidurals are less common.

Midwives tend to use less medical resources, including epidural pain management. Epidurals -- especially when given too early -- tend to increase a woman's need for more interventions and eventually, a C-section. 

Midwives have many tools at their disposal for helping patients with pain management, including breathing and relaxation techniques, movement and more comfortable positioning. 

If you are planning to get pregnant or are pregnant and would like more information on avoiding a C-section, talk to a local midwife at http://www.whallc.com about their suggested standard of care.