Quick look: New ACOG Guidelines for Preventing a C-section

The ACOG report released earlier this year clarifying situations in which interventions and c-sections can be avoided.  Knowing and discussing these with your doctor and doula may help you avoid an unnecessary c-section.  

Here is what you and they should know. (Taken from Childbirth Connection's summary of the ACOG report).  

Labor induction 

• 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.
• Before inducing labor, if a woman's cervix is not soft and ready to open, drugs or devices for cervical ripening should be used to help prepare it for labor.
• Cesarean should not be used for unsuccessful labor induction (failed induction) until at least 24 hours of labor have passed without reaching a cervical opening (dilation) of 6 centimeters.
• If membranes are broken, cesarean should not be used for unsuccessful labor induction (failed induction) until synthetic oxytocin (Pitocin, a drug that is used to start labor) has been used for at least 12 to 18 hours.

Labor before the pushing phase 

• Cesarean is not appropriate before the pushing phase of labor if labor is slow but progressing.
• Labor before the cervix is open 6 centimeters is known as latent labor. Cesarean is not appropriate just because latent labor is prolonged (i.e., has gone on for more than 20 hours in first-time mothers or more than 14 hours in experienced mothers).
• Labor after the cervix is open 6 centimeters is known as active labor. Cesarean should only be done for poor progress in active labor if 1) membranes are broken and there have been 4 hours of contractions with no progress or 2) synthetic oxytocin (Pitocin, a drug that is used to strengthen contractions) has been used for 6 hours with no progress.

Labor during the pushing phase 

• There is no fixed upper time limit for the pushing phase of labor.
• Intervention should not be used for lack of progress (arrested labor) until first-time moms have pushed for at least 3 hours and experienced moms for at least 2 hours. More time may be appropriate, e.g., if the woman is using epidural pain relief or the baby is not well-positioned for passing through the pelvis, so long as some progress is being made.
• When the baby is not well-positioned for passing through the pelvis, having a provider use a hand to move the head to a better position (manual rotation) may avoid the need for assisted vaginal birth (with vacuum extractor or forceps) or cesarean birth.
• When intervention is needed during the pushing phase of labor, a providers skilled, experienced use of a vacuum extractor or forceps is a safe alternative to cesarean birth.

Other 

• Continuous labor support, such as labor doula care, reduces risk of cesarean.
• Cesarean is not appropriate even 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, or 11 pounds, is rare).
• If a baby is breech (buttocks- or feet-first) at about 36 weeks of pregnancy, hands-to-belly movements to turn babies head-first (external cephalic version) should be offered.
• Women with twins and the first twin head-first should be encouraged to plan a vaginal birth.
• Women who have had herpes simplex virus should consider using acyclovir, a medication to prevent a late-pregnancy outbreak, and should plan a vaginal birth if the virus is inactive at labor.
• Women who are counseled about avoiding excess pregnancy weight gain may be able to avoid a cesarean.

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