Earlier this week, the American Congress of Obstetricians and Gynecologists (ACOG) along with the Society for Maternal-Fetal Medicine (SMFM) released a joint Obstetric Care Consensus: Safe Prevention of the Primary Cesarean Delivery, in response to rapidly rising first-time cesarean birth rates that have shown no improvement in the death rates for moms or babies. (Complete details on the consensus can be found on ACOG's website.) In the statement, the two groups put forth several new recommendations that propose to help prevent the first cesarean for women. If you are pregnant, you can use these new guidelines as a conversation starter during a prenatal appointment -- find out how these new suggestions measure against your care provider's routine practices. A sample summary of the recommendations is below.
A long first stage of labor -- more than 20 hours in first-time moms -- should not be cause for a cesarean. Many women are put on a time clock to dilate to 10cm, when in reality, a long labor alone should not be cause for a cesarean. If you hear statements like, "Your labor has stalled," "You are not progressing," or "Failure to progress," followed by a recommendation for cesarean, ask: "Is my baby OK? Am I OK? What's the risk in waiting or doing nothing right now? (or, what's the alternative?)"
First-time moms should be permitted to push for at least 3 hours (2 hours for second-time moms) before recommending a cesarean. Unlike what Hollywood and The Baby Story show us, pushing can take a while. It's important for moms to be given enough time to push out their baby, as long as mom and baby are both doing well.
Because induction raises the risk of cesarean, it should not be performed before 41 weeks unless medically indicated. Yes, 41 weeks! Allowing baby enough time to continue developing and for your body to gear up for labor will give you the best chance of having a healthy mom and baby.
Ultrasounds performed late in pregnancy to determine your baby's weight should be used only if there is clear indication, as these ultrasounds are linked to increased rate of cesarean for a "big baby," which is rarely a good reason for cesarean. Ultrasounds have been shown, time and again, to be off by up to (or more than) a pound in either direction. If cesarean is suggested because your baby is estimated to be too big -- get a second opinion from a care provider in another practice.
Continuous labor support -- like that provided from a doula -- is "one of the most effective tools" in improving birth outcomes. Good labor support is not just a "nice to have," but a key component to improving your care during birth. Lamaze has known this for quite some time -- check out our Healthy Care Practice number 3, "Bring a loved one, friend or doula for continuous support."
Being pregnant with twins does not automatically mean a cesarean, if twin A is in a head-down position for birth -- even if the second twin is not head down. Vaginal birth for twin mamas -- it IS possible!
Baby's position in labor should be determined -- especially if there are problems with baby moving down the birth canal -- and if possible, an attempt should be made to manually re-position baby before suggesting a cesarean. A posterior baby (where baby faces toward your front instead of your back) can cause problems in labor. Often, a baby will correct its position before birth, but not always, and this can cause issues. If you suspect an issue with your baby's position during labor, mention it to your care provider. You can ask for ultrasound in labor to verify. Ask for help with trying to get baby in a better position for birth.
Published: February 20, 2014
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Birth