Laboring women will have no choice but to push for at least two hours before they can opt for a Caesarian delivery, longer if they are giving birth for the first time.
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine have issued new guidelines governing both the doctor and the patient's decision to deliver via Caesarian section.
The new guidelines were published in the online journal of the ACOG, mentioned that in 2011, there was a 60 percent increase in Caesarian deliveries in the US, from the 1996 tally. This meant that in 2011 alone, one in three women in the country gave birth via Caesarian section.
Both the ACOG and the Society for Maternal-Fetal Medicine say that the death rate is much higher in mothers who undergo Caesarian sections, compared with those who deliver vaginally. There is a reported 13 deaths per 100,000 women who deliver via Caesarian section. Performing a Caesarian delivery on mothers who have not yet experienced contractions causes an increased risk in respiratory problems in their babies.
There are also more first-time mothers delivering their babies via Caesarian, without any compelling medical reason, raising the concern that the method could be overused. Data also shows that the increase in the number of Caesarian sections have not led to better health outcomes for both the women and their babies.
"Evidence now shows that labor actually progresses slower than we thought in the past, so many women might just need a little more time to labor and deliver vaginally instead of moving to a cesarean delivery," said Aaron B. Caughey, MD, of The College's Committee on Obstetric Practice, which developed the recommendations. "Most women who have had a caesarean with their first baby end up having repeat cesarean deliveries for subsequent babies, and this is what we're trying to avoid. By preventing the first cesarean delivery, we should be able to reduce the nation's overall cesarean delivery rate."
In the efforts to reduce the incidence of unnecessary Caesarian deliveries in those pregnant women who have no health risks, especially among first-time mothers, the guidelines encourage prolonged early phase labor, and suggests considering cervical dilation of 6 cm instead of 4 cm as the start of active labor. The guidelines also called for more time for labor to progress in the active phase.
Mothers who have delivered a bay before and recommended to push for at least two hours, while first-time mothers need to push for at least an hour more. Forceps or other methods to assist with vaginal delivery are recommended, before eventually considering a Caesarean section.
Doctors were also told not to automatically decide to perform a Caesarean section just because the baby seems very large, or when the babies are in the breech position.
The efforts at decreasing the incidence of Ceasarian deliveries also cover the pregnancy stage, in which pregnant women are discouraged from gaining excessive weight while still pregnant, as extra weight can make vaginal delivery difficult.
Recent studies also seem to be in support of vaginal childbirth. A review of 12 trials that involved over 15,000 women revealed that mothers are less likely to need a Caesarean delivery if they receive "continuous one-on-one support during labor and delivery," and are generally more satisfied with the birth experience.
A different study that included over 62,000 women showed that there seems to be a broader range of time for normal labor, which drastically influences how and when doctors decide to delivery the baby via Caesarean section.
The rise in the incidence of Caesarean deliveries could be attributed to many different factors. Some women and doctors see Caesarean sections as more convenient because they can be scheduled in advance, albeit more expensive. Doctors' fees do not dramatically rise with Ceasarian sections, but a 2013 Truven Health Analytics Marketscan Study says that insurers pay out twice as much for it, because of a longer hospital stay and more medication needed.
For pregnant women with health risks, delivering their baby via Caesarean section is the better option. However, for mothers who are healthy, pose no health risks, and first-time mothers, delivering vaginally is the method that is recommended, encouraged, and enforced.
