The American Congress of Obstetrics and Gynecologists has released new guidelines to help reduce the high rate of c-sections in the US. The guidelines encourage providers to consider a longer pushing stage (up to 3 hours), manual repositioning of the baby before/during labor and greater use of forceps/vacuum delivery when possible.
From the Obstetric Care Consensus, Number 1, March 2014
Women with low-risk pregnancies should be allowed to spend more time in labor, to reduce the risk of having an unnecessary C-section, the nation's obstetricians say.
The new guidelines on reducing cesarean deliveries are aimed at first-time mothers, according to the American College of Obstetricians and the Society for Maternal-Fetal Medicine, which released the guidelines Wednesday online and in Obstetrics and Gynecology.
About one-third of all births in the U.S. are done by C-section, and most of those are in first-time mothers. There's been a 60 percent increase in these deliveries since the 1990s, but childbirth hasn't become markedly safer for babies or mothers.
That discrepancy has led many to conclude that the operation is being overused. A C-section is major surgery. The procedure can increase complications for the mother and raise the risk during future pregnancies.
Do you think these new guidelines will help reduce cesarean rates in the US?
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We need to start being honest with first time moms about what they will experience during labor. Phrases like, "It's pressure, not pain," and "Just relax, your body knows what to do," are very damaging because a first-time mom gets very scared when her body isn't conforming to what she's heard on websites and from well-meaning people trying to keep her from being scared. We also need to dispense with this idea that "your first labor will likely be between 8 and 12 hours." Not living up to any one of these expectations causes a new mother not only to get scared and agree to a C-section when it isn't necessary, but also causes a lot of anguish after the baby is born for somehow not "doing it right." If they had a more realistic expectation of what real labor looks like and how long it lasts, they might be less worried with what their own labor does and less likely to ask for a C-section.
Who is telling moms that? I was always told 12-15 hours average first baby and it varies widely. In the mainstream I always heard it hurts like heck and you'll love the drugs, in classes I heard here are some ways to manage and work with the intensity or pain, and painless is possible if you relax enough but it's rare. Knowing what to expect plus where there is a lot of room for variation would help...but I still think a lot of it is standard interventions inhibiting labor progress or putting babies into distress. I agree that education that's both positive and HONEST is great. Less inductions, less IV's and monitoring belts, less pushing the drugs, access to better showers and baths, rooms and L&D wings less bed focused and more movement focused, less AROM and less pitocin augmentation would go a very long way too. If those problems are standard then education might lead to refusing some of it, but then you have stress and conflict in labor, which also inhibits progress.