To help pregnant women partner with their providers to make the best choices about childbirth and prevent unnecessary cesareans, Childbirth Connection, a program of the National Partnership for Women & Families, has released a new resource, New Cesarean Prevention Recommendations from Obstetric Leaders: What Pregnant Women Need to Know. The document makes the guidance from a new consensus statement from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) easily accessible to consumers. The consensus statement focuses on preventing “primary,” or initial, cesareans in women who have not had this procedure in the past.  

“One in three births in the United States today involves a cesarean, and many mothers and infants are no better off because the procedure was used,” said Maureen Corry, senior advisor for Childbirth Connection Programs. “The consensus statement found that differences in practice style across geographic areas, health systems, hospitals, or individual clinicians impact use of this procedure. Our new resource is designed to empower pregnant women to become partners in their care. It is essential that pregnant women have the information they need to prevent unnecessary cesareans.”

In Childbirth Connection’s 2013 Listening to Mothers III survey, 28% of the women who had a primary cesarean reported that they had experienced pressure from a care provider to have this procedure. The survey also revealed that most pregnant women assume they are receiving the best care. These findings indicate that pregnant women may not have the opportunity to partner with their providers and many may not recognize the need to take an active role in the decision-making process.

“Reducing unnecessary cesareans will help improve maternal and child health outcomes and reduce costs for women and families,” said Debra L. Ness, president, National Partnership for Women & Families. “The recent consensus statement has the potential to be a game-changer if pregnant women and their health care providers know about it, understand it, and pay attention to the recommendations. This new resource is designed to help make that happen.”

The new consensus statement urges 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. It also recommends ways to reduce the likelihood of having a cesarean.  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 be done for medical reasons.

• Cesarean is not appropriate when 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).

While not included in the new statement from ACOG and SMFM, Childbirth Connection identifies several other ways that pregnant women can help avert cesareans, including by choosing a care provider or group and birth setting with a relatively low cesarean rate, working with care 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.

Ness added, “We know that patients receive better care when they partner with their providers. We will continue working to facilitate partnerships between pregnant women and their providers to achieve the goal of better care and better outcomes for moms and babies.”