Concerned about the monumental increase in the number of women who have cesarean births, commonly known as C-sections, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have released a new consensus guideline urging women and their doctors to be more patient during labor instead of rushing to surgery.
In 2011, one in three U.S. births was by C-section (a birth through an incision in the abdominal wall and uterus, rather than through the vagina), which marked a 60 percent increase from 1996. Although cesarean birth can be life-saving for the baby and/or the mother in many cases, the rapid increase in cesarean birth rates raises concern that cesarean delivery is overused without clear evidence of improved maternal or newborn outcomes, according to the guideline.
Increased Risk of Infant Breathing Problems, Maternal Fatalities
According to the report, the death rate is three times higher in mothers who have C-sections, compared with those who deliver vaginally. There are 13 deaths per 100,000 women who deliver via cesarean section.
And performing a C-section on mothers who have not yet experienced contractions causes an increased risk in respiratory problems in their babies.
Allowing most women with low-risk pregnancies to spend more time in the first stage of labor may avoid unnecessary C-sections, according to the consensus. The new recommendations are targeted at preventing women from having C-sections with their first birth and at decreasing the national cesarean rate.
“Physicians do need to balance risks and benefits, and for some clinical conditions, cesarean is definitely the best mode of delivery,” says Vincenzo Berghella, M.D., president of the SMFM, 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.”
Leah Marinelli, a certified nurse midwife at Homebirth With Love in Rockland County, N.Y., told Healthline that if a woman has two or three C-sections for subsequent births, she is at risk for complications with her future pregnancies.
“Every time a woman has a C-section, her risk is much higher," explained Marinelli, who was not involved in developing the new guideline. "Nurses are seeing more placenta accretas, which is when the placenta grows into the uterus. This a very unusual, horrible complication, and it’s life-threatening. Now, when women are coming in for third or fourth C-sections, nurses are seeing a lot more placenta accretas.”
“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, M.D., a member of the ACOG's Committee on Obstetric Practice who helped develop the new recommendations.
Caughey explained, “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.”
Some women and doctors also see C-sections as more convenient, because they can be scheduled in advance, according to Caughey. Some women want to guarantee that their preferred doctor will be available when they deliver, for instance.
“They think, I don’t have to go through labor; they may think labor is so bad," said Marinelli, "but they have to recover from the surgery, and the recovery becomes harder and harder for each C-section.”
How to Decrease Cesarean Deliveries
The guidelines call for the following ways to decrease cesarean deliveries, including:
- Allow prolonged latent (early) phase labor.
- Consider cervical dilation of 6 centimeters (instead of 4 centimeters) as the start of active phase labor.
- Allow more time for labor to progress in the active phase.
- Allow women to push for at least two hours if they have delivered before, three hours if it’s their first delivery, and even longer in some situations (for example, with an epidural).
- Use techniques to assist with vaginal delivery. (This may include the use of forceps, for example.)
- Encourage patients to avoid excessive weight gain during pregnancy.
Many experts recommend performing C-sections only when they are absolutely necessary—when it’s impossible or unsafe for the mother to deliver the baby through the vagina. Some reasons for performing a C-section include a baby in an abnormal position (such as feet first, or breech), a baby with developmental problems, a mother with health problems, and problems with the placenta or umbilical cord—such as placenta previa, placental abruption, and umbilical cord prolapse.