4 New Approaches to the C-Section Decision | Fit Pregnancy

4 New Approaches to the C-Section Decision

Revised guidelines for docs that can help you sidestep surgery.

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Big news, ladies! New C-section guidelines are coming to a hospital near you. The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) are addressing what some of us have known for years: many of the C-sections that account for 1 in 3 births are unnecessary and harmful.

“Cesarean birth can be life-saving for the fetus, the mother, or both in certain cases,” says the new statement on C-sections published in The Green Journal. Still, there’s “significant concern that cesarean delivery is overused.”

Three syllables: Fi-nal-ly.

Even better: The paper expresses more than just concerns. It provides actionable guidelines. Here, the key takeaways to discuss with your OB-GYN and/or midwife before delivery day.

The C-section cause: The baby is taking too long.

Thirty four percent of C-sections are done because mom isn’t dilating, or because the baby isn’t descending into the birth canal as quickly as doctors want it to.

Here's the problem with the presuming things are taking too long: A 1950s guideline, the Freidman curve, determines normal rates for labor progression. Recent data shows that labor can take considerably longer than anticipated by Friedman (and today’s doctors), and still result in a normal vaginal delivery and a healthy mother and baby.

The new guidelines:
The active (pushing) phase of labor begins when the cervix is dilated 6 cm (previously, 4 cm). Before then, as long as you and your baby are fine, you shouldn’t even be evaluated for labor dystocia (the term used for a slow or difficult labor).

C-sections for labor dystocia should be reserved for women at or beyond 6 cm of dilation with ruptured membranes who don’t progress despite 4 hours of contractions, or women who have been on Pitocin (which strengthens and regulates contractions) for 6 hours with no progress.

Related:  When Labor Stalls

The C-section cause: The baby isn’t handling labor well.

Abnormal or unestablished fetal heart rate tracings cause 23 percent of C-sections.

We know that babies’ heart rates will dip and rise throughout the course of labor—not usually a big deal. But when heart rates are continuously tracked on paper, providers are motivated to fix them (even when there's really nothing wrong). As doctors will say, "you won’t get sued for the C-section—you'll get sued for the one you didn’t do, but should have."

The new guidelines:
Before going to the operating room for an abnormal heart rate, doctors should investigate further. Example: They can do something called “fetal scalp stimulation,” which involves rubbing the baby’s head to increase the heart rate.

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