Docs Push for More Pushing, Fewer C-Sections
Moms-to-be might have to push a little longer before being offered a C-section.
New guidelines issued today by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend that laboring women push for at least two hours before considering a cesarean delivery. First-time moms and epidural-users should push even longer, according to the guidelines.
"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," ACOG's Dr. Aaron Caughey, who helped develop the guidelines, said in a statement.
Roughly one in three babies is born by C-section, according to the U.S. Centers for Disease Control and Prevention - up 60 percent since 1996. The new guidelines aim to curb the trend by promoting vaginal births among first-time moms and reserving C-sections for special cases.
"Most women who have had a cesarean with their first baby end up having repeat cesarean deliveries for subsequent babies, and this is what we're trying to avoid," said Caughey. "By preventing the first cesarean delivery, we should be able to reduce the nation's overall cesarean delivery rate."
The guidelines recommend that women push for at least two hours if they've delivered before, three hours if it's their first delivery and even longer if they've had an epidural. They also promote the use of "techniques to assist with vaginal delivery," such as forceps, according to a statement.
Women are also encouraged to avoid excessive weight gain during pregnancy, which raises the risk of a cesarean delivery.
While C-sections are expensive and carry risks that vaginal deliveries don't, they're sometimes the safer option for mom and baby.
"Physicians do need to balance risks and benefits, and for some clinical conditions, cesarean is definitely the best mode of delivery," SMFM President Dr. Vincenzo Berghella said in a statement. "But for most pregnancies that are low-risk, cesarean delivery may pose greater risk than vaginal delivery, especially risks related to future pregnancies."