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 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.

The C-section cause: Baby's positioning is off.

Fetal malpresentation, when Baby isn't positioned headfirst, accounts for 17 percent of C-sections.

Currently, C-sections deliver 85 percent of these babies, even though many could be maneuvered into the proper position.

The new guidelines: Versions (when the doctor pushes on your abdomen to flip your baby into the right position) are often successful, but data shows doctors are doing fewer versions than ever. Doctors should offer and perform versions whenever possible.

The C-section cause: You're having twins!

Multiple babies (twins, triplets, and so on) make up seven percent of C-sections.

Many times, one of the babies will be in the wrong position, but even so, vaginal birth can be successful (see above).

The new guidelines: Patients should be encouraged to attempt vaginal births. Residents should be trained and obstetric care providers provided ongoing training to maintain skills needed to perform twin vaginal deliveries.

Related: How Safe Is a Vaginal Birth for Twins?

The C-section cause: The baby is too big.

Suspected fetal macrosomia is to blame for four percent of C-sections.

Translation: Your doctor thinks your baby is too big for a vaginal birth.

The new guidelines: It's extremely difficult to determine how big a baby is prior to birth, especially based on ultrasound. It's also difficult to know how big of a baby you can deliver. That's why new guidelines say suspected fetal macrosomia isn't a reason to do a C-section.

Shouting Hallelujah! yet? Just remember: It may take a while before all doctors are comfortable changing the way they practice. If your doctor suggests it's time to go to the OR, ask her about these guidelines, and don't be shy saying you'd rather hang tight.

Related: Why Unnecessary C-Sections Do More Harm Than Good