New Guidelines Address Rapid Rise in C-Sections

Two medical groups are hoping to decrease the nation’s cesarean rate by implementing a new set of guidelines that would allow women with low-risk pregnancies more time to labor.

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, jointly issued the guidelines, hoping doctors will get on board with their desire to prevent unnecessary c-sections.

“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.”

According to the report, one in three American women gave birth by cesarean delivery in 2011, which was a 60 percent increase since the mid-90s. Cesarean births are medically necessary in some cases, and can be life-saving for both the baby and mother. However, the groups are significantly concerned that c-sections are overused.

The recommendations, published Thursday, call for allowing prolonged early labor phase and considering the cervical dilation of 6 cm, rather than 4 cm as the start of the active labor stage, as well as allowing more time for labor to progress in the active stage.

The guidelines allow women to push for at least two hours if they’ve delivered before, three hours if it’s their first delivery and even longer in other situations (like with an epidural). Using techniques to assist with vaginal delivery, like forceps, is recommended, as well as 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.”

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Liz Hayes
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