A third of babies born in the U.S. are delivered by cesarean section, often referred to as a C-section, and researchers estimate that about half these surgeries are medically unnecessary. The other half, of course, can be lifesaving surgeries that ensure the safest delivery for a mother and her baby, so it's impossible to guarantee that you can avoid a C-section. But you can reduce the likelihood that you will need a C-section or end up having one that is not medically necessary, exposing you to specific harms (such as infection), and almost guaranteeing a C-section in subsequent births.

Several factors can increase the chance of having a C-section, such as being older, overweight, or having diabetes. Yet the biggest risk "may simply be which hospital a mother walks into to deliver her baby and how busy it is," says Neel Shah, M.D., an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, who has studied C-section rates in this country and around the world. A Consumer Reports analysis of more than 1,300 hospitals found that C-section rates for low-risk deliveries among U.S. hospitals vary dramatically, even in the same communities and among similar institutions, and that in most hospitals the rates are above national targets.

Reducing unnecessary C-sections is ultimately the responsibility of hospitals and providers, and although there are efforts underway at medical institutions across the U.S, it can take a long time for hospitals to change their approach to childbirth. So you can take the following steps yourself to help reduce your risk of having a C-section procedure.

1. Find Out Your Hospital's C-Section Rate

Start with our hospital ratings. Though you might think your doctor or midwife is where you should start, it is possible that your baby will not be delivered by your regular provider, so it is important to know about the hospital's overall rate.

If your hospital is not included in our ratings, ask your doctor or midwife about the hospital's rates. A hospital's C-section rate for low-risk deliveries for first-time moms should be below 23.9 percent. If your hospital does not publicly report its data, ask why—and ask what its rate is. If it doesn't tell you, consider going to another hospital.  

2. Choose Your Provider Carefully

It's good to know the C-section rates for your doctor or midwife, too, so ask whether his or her practice tracks C-section procedures. "Even if they don't know the exact percent, providers should be able to articulate their philosophy about supporting vaginal birth," Caughey says. Also ask how the guidelines from the American College of Obstetricians and Gynecologists may affect the practice's approach to labor and delivery. If your provider is unaware of the new standards, or is dismissive of them, you may want to find a different one.

3. Consider Using a Midwife

If you have a low- to moderate-risk pregnancy, you can consider using a nurse midwife as a primary care provider if they are available in your area. Midwives do not do surgery, so they transfer a woman to an obstetrician's care when a C-section is medically necessary or if serious complications arise. A variety of midwife types exist, so ask about their credentials. Certified nurse midwives have both midwifery and nursing education and are the midwives usually employed by hospitals.

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4. Stay Home During Early Labor

Discuss with your provider at what point in labor you should go to the hospital. Some of the interventions that increase your risk of an unnecessary C-section can be avoided by delaying your admission to the hospital.

For a first baby, some practitioners have told us that a helpful way of remembering what to do is "311": After conferring with your doctor or midwife, consider delaying your trip to the hospital until your contractions are less than 3 minutes apart, last for 1 minute, and have been like this for 1 hour. (Note that some providers prefer "411" or "511," especially if the hospital is not nearby.)  

If doing this is not possible because transportation problems and/or your distance from the hospital, find out beforehand where you can safely walk around somewhere near the hospital.

Don't be disappointed, though, if once you're there the staff checks you and does not admit you. "Until a woman's cervix is dilated to 3 or 4 centimeters, she usually doesn't need to be in the hospital setting," says Elliott Main, M.D., medical director of the California Maternal Quality Care Collaborative. "She'll usually be more comfortable and labor will even progress more smoothly at home."

5. Don't Rush to Induce Labor

Doctors should not try to induce labor unless there's a good medical reason—for example, if a woman's membranes rupture (her "water breaks") and labor doesn't start on its own, if she has complications such as pre-eclampsia, or if she is a week or more past her due date. Trying to induce labor before a woman's body is ready can sometimes increase the likelihood of surgical delivery if labor doesn't progress. So do not rush to request induction of labor, and if a doctor suggests inducing labor, ask why.

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6. Don't Jump to Conclusions About Big Babies

The possibility of a large baby is frequently used to justify a cesarean delivery, but that's not warranted, according to professional guidelines for doctors. To begin with, methods used to assess the baby's weight toward the end of the pregnancy are not very accurate. Also, babies usually have to be 11 pounds or larger to justify a scheduled cesarean, according to Caughey.

7. Get Support During Labor

Consider hiring a doula, a trained birth assistant who can provide physical and emotional support throughout labor and delivery. Women who have continuous support from someone who is not a friend, a family member, or a member of the hospital staff labor for shorter periods and are less likely to need interventions, research shows. Ask your insurer whether it will cover doula care.

8. Ignore the Clock During Labor

The ACOG guidelines call for allowing more time in each phase of labor and delivery. In the past, a doctor's assessment that a pregnancy was not progressing fast enough has been a common reason to initiate a C-section before it's medically necessary, Caughey says. In general, decisions on whether to intervene should be based on how well mothers and babies are doing, not how much time has passed.