February 20, 2014 — Doctors should give healthy pregnant women more time to labor before considering a caesarean section, according to guidelines published Thursday by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, the AP/Washington Post reports.
The guidelines are the latest effort to reduce c-sections, which account for one in three births in the U.S. Although the surgery can be lifesaving, it carries serious health risks and is sometimes performed for non-medical reasons, such as convenience or physicians' fear of lawsuits.
An analysis by ACOG found that one of the primary reasons for a first-time c-section is that the physician believes labor is moving too slowly. However, there are no definitive standards on how long labor should take, and research suggests that the normal length of labor has increased over the past several decades, meaning that what doctors learned during medical school might be out of date.
The new guidelines apply to low-risk pregnancies.
ACOG and SMFM said doctors should not perform a c-section solely because of a prolonged first stage of labor, known as the latent phase, when contractions are expected to be mild and far apart and the woman's cervix is barely dilated. This is the longest stage of labor and was conventionally considered stalled if lasting for more than 20 hours in a first pregnancy and 14 hours in other pregnancies.
In addition, doctors should be aware that recent research shows the stage known as active labor begins when the cervix is dilated to six centimeters, not four centimeters as previously thought. This change is important because many hospitals do not admit women until they are in active labor, which is when contractions become stronger and more frequent and the cervix begins to dilate more rapidly.
The guidelines also said doctors should allow women to push for at least three hours during their first time giving birth and at least two hours during subsequent births, unless the woman is too tired. Women who have had an epidural, which can slow labor, can push even longer if the doctor can see progress.
Doctors who are well-trained and experienced with forceps should consider them a safe alternative to a c-section, the guidelines added. However, few doctors today receive such training (AP/Washington Post, 2/19).