The quality of maternity care in our country needs improvement. While transforming the maternity care system will take time, there is progress to report.
In February, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released a groundbreaking consensus statement on the overuse of cesarean. The statement confirms that the procedure is too often used in ways that do not improve maternal and child health outcomes.
The statement also provides new clinical guidance to health care providers on how to prevent unnecessary cesareans in women who have not had the procedure before. Of course, the new statement acknowledges, and we all recognize, that in some cases cesareans are needed.
While it’s critical that providers have up-to-date information about best practices, that alone is not enough to reduce the rate of unnecessary procedures and improve maternity care. Pregnant women need to be informed as well. There are huge variations in how providers and hospitals and birth centers administer care; for instance, some providers and hospitals have rates of cesarean that are much higher than others, and there is no discernable explanation. That is why pregnant women need to take an active role in their care by partnering with their providers to make informed choices about childbirth and prevent unnecessary cesareans.
To help pregnant women partner with their providers, Childbirth Connection Programs has developed a new resource “New Cesarean Prevention Recommendations from Obstetric Leaders: What Pregnant Women Need to Know.” It presents recommendations from the ACOG and SMFM consensus statement in a way that is consumer-friendly.
The new guidelines urge care providers to be sure that a woman’s body is ready for labor, to be patient with labor, and to provide good care and support during labor. They also recommend ways to reduce the likelihood of having a cesarean. Pregnant women should become familiar with these recommendations. Five key recommendations include:
- Labor induction (using drugs or other methods to try to cause labor to start) before the 41st week of pregnancy should generally be done for medical reasons.
- Cesarean is not appropriate just because latent labor (labor before the cervix is opened to six centimeters) is “prolonged,” that is, has gone on for more than 20 hours in first-time mothers or more than 14 hours in experienced mothers.
- Cesarean is not appropriate during latent labor if labor is slow but progressing.
- There is no fixed upper time limit for the pushing phase of labor.
- Cesarean is not appropriate for most babies that are estimated to be large near the end of pregnancy (estimates are often wrong, and many large babies are born vaginally). It may be appropriate if the baby is estimated to be at least 4,500 grams in women with diabetes and at least 5,000 grams in other women (5,000 grams is about 11 pounds and is rare).
In addition to the recommendations included in the new consensus statement, we have identified several ways pregnant women can help prevent cesareans, including choosing a care provider or group and birth setting with a relatively low cesarean rate, working with providers to delay going to the hospital until labor is well under way, and staying upright and moving around in labor before the pushing phase. For more information about cesarean section, pregnant women can access our comprehensive resource, “What Every Pregnant Woman Needs to Know about Cesarean Section.”
Right now, too many pregnant women in this country do not receive safe and effective care based on the best available research. This exposes them and their babies to the potential of unnecessary harm and wastes precious resources. The consensus statement on reducing primary cesarean sections has the potential to be a game-changer by encouraging providers to adjust their practices according to the best available evidence, if necessary, and empowering pregnant women to be actively involved in making informed decisions that are aligned with their values and preferences. When this happens, we will see rapid gains in the quality, outcomes and value of maternity care for moms and babies.
