In Florida today, 37% of all women give birth to their baby by way of cesarean. Many first time moms find themselves having a C-section because of a failure to progress during labor or because of concerns over abnormal fetal heart rate. Other women prefer a C-section because of its convenience and “no mess” factor.
But two of the leading authorities in maternal and fetal health have issued new labor recommendations for doctors as a way to prevent what they view as unnecessary and potentially more dangerous C-sections.
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine released their joint statement in the March 2014 issue of Obstetrics and Gynecology.
The statement encourages doctors to essentially change some of the ways they think about childbirth. For instance, modern labor is taking more time than historically thought. This may be because of older maternal age, higher maternal weight, or the use of medications that can slow the progress of labor.
The statement urges doctors to allow longer latent labor phases and emphasizes that a long early labor doesn’t warrant a C-section.
Other changes to labor guidelines include:
- The definition of active labor. Until now, doctors considered a woman in active labor when she became four centimeters dilated. Now, doctors should consider active labor to begin at 6cm dilation.
- Women who have never had a baby before should be allowed to push for three hours or potentially longer if they’ve had medication. Second time mothers should be allowed to push for two hours.
- Since fetal heart rate concerns often initiate a C-section, the way doctors and nurses measure and interpret fetal heart rate should be improved and standardized across the profession.
- Doctors should be trained in and maintain manual delivery skills like the use forceps, which can be a safe alternative to a C-section.
The statement also urges that women are given continuous labor and delivery support, a step that is known to reduce the use of a C-section. This support may come from hospital support staff or a privately hired doula.
While C-sections are the safest delivery method for women with conditions such as uterine rupture or placenta previa, the ACOG emphasizes that C-sections are not the best delivery method for low-risk mothers. For most mothers, having a C-section increases the risk of severe maternal health risks by three fold.
These risks include:
- Hemorrhage requiring transfusion or hysterectomy
- Cardiac Arrest
Furthermore, a C-section “increases risks of adverse neonatal outcomes,” particularly the risk that a baby will suffer respiratory problems that are highly unusual in babies born vaginally.
The greatest concern of the ACOG and SMFM though is on what they call the “downstream effects” on women who have more than one cesarean. The risk of placental abnormalities, such as placenta previa, increases with each subsequent pregnancy for women who’ve had a C-section. By aiming efforts to reduce first time C-sections, the organizations hope that the risk of subsequent ones will also be reduced.
The newly recommended standards for labor are considerable changes to the way labor and delivery is currently dealt with across the nation, and the change in practices may take time to adapt to.
If you have concerns about labor and delivery, be sure to talk to your obstetrician or midwife. At Gainesville’s All About Women, we aim to provide the highest level of care for all of our expectant mothers. You can learn more about pregnancy, labor, and delivery by visiting our Knowledge Center.