Cesarean Delivery

This article presents new research and strategies to safely reduce the rate of primary Cesarean delivery.

One out of three deliveries is by Cesarean.  In certain situations, Cesarean can be life-saving for both mother and baby.  But Cesarean deliveries aslo carry greater risks for mothers—research has shown that women who deliver their first baby by cesarean are more likely to need blood transfusions and be admitted to the ICU than women who have a vaginal delivery.  In addition, after that first C/S, nine out of 10 women will have their next infant delivered by repeat C/S.

To improve maternal outcomes and reduce the complications associated with Cesarean delivery, it is most important to reduce primary Cesarean delivery.  In a joint document written by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, multiple evidence-based recommendations are outlined.  Selected recommendations are included below.

First Stage of Labor

A prolonged latent phase (eg. greater than 20 hours in nulliparous women and greater than 14 hours in multiparous women) should NOT be an indication for cesarean delivery.

Slow but progressive labor in the first stage of labor should not be an indication for Cesarean delivery.

Cervical dilation of 6cm should be considered the threshold for the active phase of most women in labor.  Thus, before 6cm of dilation is achieved, standards of active phase progress should not be applied.

Cesarean delivery for active phase arrest in the first stage of labor should be reserved for women at or beyond 6cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change.

References

Curtin SC, Gregory KD, Korst LM, Uddin SF.  Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History: New Data From the Birth Certificate, 2013.  Natl Vital Stat Rep. 2015;64(4):1-13.

Safe prevention of the primary cesarean delivery.  Obstetric Care Consensus. No. 1.  American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:693-711.