Doctors Urged To Wait Before Performing C-Sections

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Show more patience in the delivery room: That's the prescription being given to the nation's obstetricians.

"Labor takes a little longer than we may have thought," said Dr. Aaron Caughey, obstetrics chairman at the Oregon Health and Sciences University, who co-authored new guidelines for the American College of Obstetricians and Gynecologists.

The recommendations are being published jointly Thursday by two groups of pregnancy specialists — ACOG and the Society for Maternal-Fetal Medicine — amid growing concern that C-sections are overused. Nearly 1 in 3 women in the U.S. gives birth by cesarean.

Among the recommendations for otherwise low-risk mothers and babies:

Don't order a C-section just because the first and longest phase of labor is prolonged. This so-called latent phase is when contractions are mild and far apart, and the mother's cervix is barely dilated. Historically doctors considered it stalled if it lasted longer than 20 hours for a first-time mom, or 14 hours for other mothers.
"Active labor" begins later than once thought, not until the cervix is dilated 6 centimeters. Active labor is when contractions become stronger and more frequent, and the cervix begins to dilate more rapidly until the woman eventually is ready to push. Doctors once thought active labor began when the cervix was dilated 4 centimeters, but recent research shows that dilation remains pretty slow until reaching the new threshold.
If women aren't too tired, allow them to push at least two hours if they have delivered before, three hours if it's their first baby. They may push longer if they had an epidural as long as the doctor can see progress.
Forceps can offer a safe alternative to certain cesareans if used by an experienced, well-trained physician. Few physicians today undergo the training.
Some women's groups have long warned that rushed labor was fueling cesareans, and Lamaze International welcomed the guidelines and said mothers-to-be need to know them, too.

"They need to have a better understanding of what normal labor is," said Lamaze president Michele Ondeck.


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