While the cesarean section rate has risen to 1 in 3 births, there has not been a concurrent rise in improved maternal and neonatal outcomes. Research data show that variation in practice affects the cesarean section rate in different regions.
In March 2014 the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) released a new Obstetric Care Consensus on the Safe Prevention of the Primary Cesarean Delivery. These organizations recognize the need to prevent a continued increase of cesarean sections, particularly the primary cesarean. The new care guidelines recognize the need to revise the definition of labor dystocia, and urge care providers to improve and standardize fetal heart rate interpretation.
The new recommended guidelines include:
- Women giving birth for the first time should be allowed to spend more time in labor, with the start of active labor redefined to 6 centimeters cervical dilation. A prolonged latent phase (>20 hours) in nulliparous women is not an indication for cesarean delivery.
- Women should be allowed to push for at least three hours; four hours if the woman has received an epidural.
- Induction of labor increases the risk of cesarean section, and prior to 41 0/7 weeks should be performed only with medical indication.
- Instrument delivery (e.g. forceps) can reduce the need for surgical delivery.
- Suspected macrosomia is not an indication for cesarean delivery.
- Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.
Written By: Emily A. Bronson, MA, MPH