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Guidelines to Lower C-Section Rates

The two organizations say first-time mothers should be allowed more time in labor

WebMD News from HealthDay

By Robert Preidt

HealthDay Reporter

WEDNESDAY, Feb. 19, 2014 (HealthDay News) -- Two major medical groups representing America's obstetricians/gynecologists issued joint guidelines on Wednesday aimed at curbing the overuse of cesarean sections in first-time mothers.

One major change: Extending the length of time a woman should be allowed to be in labor, to help lower the odds she will require a C-section.

"This is an extremely important initiative to prevent the first cesarean delivery," said one expert, Dr. Joanne Stone, director of maternal-fetal medicine at The Mount Sinai Hospital in New York City.

"Multiple cesarean sections put women at higher risks for complications, such as abnormal placental adherence, bleeding and even hysterectomy," she said. Also, "by preventing the first cesarean, we can prevent future cesareans."

According to an American College of Obstetricians and Gynecologists news release, about one-third of American women gave birth by C-section in 2011, a 60 percent rise since 1996. And the doctors' group said that women having their first child account for about 60 percent of all cesarean deliveries in the United States.

However, the new guidelines now say that first-time mothers with low-risk pregnancies should be allowed to have more time in labor, to help lower their risk of having an unnecessary cesarean delivery.

Among the other guidelines:

  • Active labor should be considered to begin at a cervical dilation of 6 centimeters, rather than the previous 4 centimeters.
  • Women should be allowed to push for at least two hours if they've given birth before, three hours if they are first-time mothers, and even longer in certain cases, such as when an epidural is used for pain relief.
  • Vaginal delivery is the preferred option whenever possible and doctors should use techniques -- forceps, for example -- to assist with natural birth.
  • Women should be advised to avoid excessive weight gain during pregnancy.

The recommendations will be published in the March issue of the journal Obstetrics & Gynecology.

"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," Dr. Aaron Caughey, a member of ACOG's committee on obstetric practice who helped develop the new recommendations, explained in the news release.

"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," Caughey said.

Dr. Vincenzo Berghella, who is president of the Society for Maternal-Fetal Medicine and a contributor to the new guidelines, added in the news release: "Physicians do need to balance risks and benefits, and for some clinical conditions, cesarean is definitely the best mode of delivery. But for most pregnancies that are low-risk, cesarean delivery may pose greater risk than vaginal delivery, especially risks related to future pregnancies."

Dr. Mitchell Maiman is chairman of obstetrics and gynecology at Staten Island University Hospital, in New York City. He said that "as long as the fetal heart patterns are being safely monitored, low-risk [first pregnancy] patients need not exactly follow strict guidelines and labor curves established decades ago, and that time, patience, clinical individualization and a hands-off approach are preferable to decrease the rate of unnecessary cesarean sections."

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