Nation’s Ob-Gyns Take Aim at Preventing Cesareans

February 19, 2014

Washington, DC — Allowing most women with low-risk pregnancies to spend more time in the first stage of labor may avoid unnecessary cesareans, according to The American College of Obstetricians and Gynecologists (The College) and the Society for Maternal-Fetal Medicine (SMFM). In a jointly-issued Obstetric Care Consensus guideline, the new recommendations are targeted at preventing women from having cesareans with their first birth and at decreasing the national cesarean rate.

“Evidence now shows that labor actually progresses slower than we thought in the past, so many women might just need a little more time to labor and deliver vaginally instead of moving to a cesarean delivery,” said Aaron B. Caughey, MD, a member of The College’s Committee on Obstetric Practice who helped develop the new recommendations. “Most women who have had a cesarean with their first baby end up having repeat cesarean deliveries for subsequent babies, and this is what we’re trying to avoid. By preventing the first cesarean delivery, we should be able to reduce the nation’s overall cesarean delivery rate.”

In 2011, one in three women in the US gave birth by cesarean delivery, a 60% increase since 1996. Today, approximately 60% of all cesarean births are primary cesareans. Although cesarean birth can be life-saving for the baby and/or the mother, the rapid increase in cesarean birth rates raises significant concern that cesarean delivery is overused without clear evidence of improved maternal or newborn outcomes.

Safe Prevention of the Primary Cesarean Delivery discusses ways to decrease cesarean deliveries, including:

• Allowing prolonged latent (early) phase labor.
• Considering cervical dilation of 6 cm (instead of 4 cm) as the start of active phase labor.
• Allowing more time for labor to progress in the active phase.
• Allowing women to push for at least two hours if they have delivered before, three hours if it’s their first delivery, and even longer in some situations, for example, with an epidural.
• Using techniques to assist with vaginal delivery, which is the preferred method when possible. This may include the use of forceps, for example.
• Encouraging patients to avoid excessive weight gain during pregnancy.

“Physicians do need to balance risks and benefits, and for some clinical conditions, cesarean is definitely the best mode of delivery,” said Vincenzo Berghella, MD, SMFM President, who helped develop the new recommendations. “But for most pregnancies that are low-risk, cesarean delivery may pose greater risk than vaginal delivery, especially risks related to future pregnancies.”

The College and SMFM encourage physicians, organizations, and governing bodies to conduct research that provides a better knowledge base to guide decisions about cesarean delivery and to encourage policy changes that safely lower the rate of primary cesarean delivery.

Safe Prevention of the Primary Cesarean Delivery is the first in a new Obstetric Care Consensus series from the College and SMFM; the series will provide high-quality, consistent, and concise clinical recommendations for practicing obstetricians and maternal-fetal medicine subspecialists.

Obstetric Care Consensus #1 “Safe Prevention of the Primary Cesarean Delivery” is published in the March issue of Obstetrics & Gynecology.

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Additional Resources:

• Primary Cesarean Delivery Rates, by State: Results From the Revised Birth Certificate, 2006–2012.
• Committee Opinion #559 “Cesarean Delivery on Maternal Request” (April 2013)
• Committee Opinion #579 “Definition of Term Pregnancy” (November 2013)
• Practice Bulletin #115 “Vaginal Birth After Previous Cesarean Delivery” (Reaffirmed 2013)
• Patient FAQ: Cesarean Birth (C-section)