March 2014 – The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have released the first guideline, Safe Prevention of the Primary Cesarean Delivery, in a new Obstetric Care Consensus series.
The new recommendation was developed with the overall goal of reducing the US national cesarean rate by safely preventing women from having unnecessary cesarean deliveries with their first birth. Some of the key recommendations include:
- Allowing women with low-risk pregnancies to have a longer first stage of labor.
- Considering a new definition for the start of the active phase of labor: 6cm cervical dilation, instead of 4cm.
- Increasing the length of the second stage of labor to two hours for multiparas, three hours for nulliparas and even longer in certain cases, such as the use of an epidural.
- Avoidance of excessive weight gain in pregnancy.
- Utilizing tools to assist with vaginal delivery, such as forceps and vacuum.
ACOG and SMFM are encouraging individuals, organizations and governing bodies to conduct research aimed at developing a stronger knowledge base to direct decisions regarding cesarean delivery and to facilitate policy changes that safely lower the rate of primary cesarean births in the US.
The guideline can be viewed on the ACOG website.