To
help pregnant women partner with their providers to make the best
choices about childbirth and prevent unnecessary cesareans, Childbirth
Connection, a program of the National Partnership for Women
& Families, has released a new resource, New Cesarean Prevention Recommendations from Obstetric Leaders: What Pregnant Women Need to Know.
The document makes the guidance from a new consensus statement from the
American College of Obstetricians and Gynecologists (ACOG) and the
Society for Maternal-Fetal Medicine (SMFM) easily accessible to
consumers. The consensus statement focuses on preventing
“primary,” or initial, cesareans in women who have not had this
procedure in the past.
“One
in three births in the United States today involves a cesarean, and
many mothers and infants are no better off because the procedure was
used,” said Maureen Corry,
senior advisor for Childbirth Connection Programs. “The consensus
statement found that differences in practice style across geographic
areas, health systems, hospitals, or individual clinicians impact use of
this procedure. Our new resource is designed to
empower pregnant women to become partners in their care. It is
essential that pregnant women have the information they need to prevent
unnecessary cesareans.”
“Reducing
unnecessary cesareans will help improve maternal and child health
outcomes and reduce costs for women and families,” said Debra L. Ness,
president, National
Partnership for Women & Families. “The recent consensus statement
has the potential to be a game-changer if pregnant women and their
health care providers know about it, understand it, and pay attention to
the recommendations. This new resource is designed
to help make that happen.”
The
new consensus statement urges care providers to be sure that a woman’s
body is ready for labor, to be patient with labor, and to provide good
care and support during
labor. It also recommends ways to reduce the likelihood of having a
cesarean. Five key recommendations include:
·
Labor induction
(using drugs or other methods to try to cause labor to start) before the
41st week of pregnancy should be done for medical reasons.
·
Cesarean is not
appropriate when latent labor (labor before the cervix is opened to six
centimeters) is “prolonged,” that is, has gone on for more than 20 hours
in first-time mothers or more than 14 hours in experienced mothers.
·
Cesarean is not appropriate during latent labor if labor is slow but progressing.
·
There is no fixed upper time limit for the pushing phase of labor.
·
Cesarean is not
appropriate for most babies that are estimated to be large near the end
of pregnancy (estimates are often wrong, and many large babies are born
vaginally). It may be appropriate if the baby is estimated to be at
least 4,500 grams in women with diabetes and at least 5,000 grams in
other women (5,000 grams is about 11 pounds).
While
not included in the new statement from ACOG and SMFM, Childbirth
Connection identifies several other ways that pregnant women can help
avert cesareans, including
by choosing a care provider or group and birth setting with a
relatively low cesarean rate, working with care providers to delay going
to the hospital until labor is well under way, and staying upright and
moving around in labor before the pushing phase.
Ness
added, “We know that patients receive better care when they partner
with their providers. We will continue working to facilitate
partnerships between pregnant women
and their providers to achieve the goal of better care and better
outcomes for moms and babies.”
The
National Partnership for Women & Families is a nonprofit,
nonpartisan advocacy group dedicated to promoting fairness in the
workplace, access to quality health care and policies that help women
and men meet the dual demands of
work and family. More information is available at
www.NationalPartnership.org.
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