ACOG’s consensus statement on preventing first-time cesareans

Lamaze InternationalFeb 20 2014

Today's release of the American College of Obstetricians and Gynecologists' (ACOG) consensus statement on preventing first-time cesareans is an important step in closing gaps between evidence and the day-to-day care that women receive in pregnancy and labor. 

While cesareans can save lives when used appropriately, it exposes women and babies to real health risks when it's used without true medical need. ACOG's consensus statement reflects research, both new and old, and aligns with the fundamentals of Lamaze's Six Healthy Birth Practices that educators have taught for years. If adopted into practice, Lamaze expects these recommendations will lower the number of cesareans and associated complications for women and their babies.

The statement covers a multitude of important prevention strategies, and several key takeaways include:

• Women are being rushed into cesareans they don't need. The message for care providers is clear - stop putting a strict clock on laboring women. As long as mother and baby are doing well, labor should be allowed to progress at its own rate. Labor should be considered active starting at 6 cm dilation, not 4 cm.
• Providers are resorting to cesareans before exploring alternatives. Factors that have long been considered an "automatic cesarean" – like suspected large baby, carrying twins or a malpositioned baby – are not based in evidence, and ACOG calls on their members to change their practice.

While this paper is focused on preventing primary cesarean, it should be noted that VBAC (Vaginal Birth After Cesarean) continues to be grossly underutilized in lowering the overall cesarean rate, and women still routinely face obstacles in accessing VBAC, including bans, misinformation or provider surcharges.  

ACOG rightly acknowledges that systemic change will be hard, and that there are many barriers to implementation. This is why it's critical for women to have the education, resources and support they need to push for evidence-based care now, rather than waiting for providers to change their practice.  In short, women don't have be doctors to understand how to push for the safest, healthiest birth possible.

Women should have the information and confidence to ask key questions that will help reduce her risk of having a cesarean. 

• In early pregnancy, ask your provider about his or her personal cesarean rate.  Interview other providers and see how rates compare. Also, what is the hospital's rate, do they have measures in place to reduce the cesarean rate. Hire a doula for labor support. Women who have continuous labor support are less likely to have a cesarean.
• During pregnancy, ask about your provider's approach to situations like breech baby, long labor, suspected large baby, or going past the estimated due date. These discussions will give you important information about your provider's approach to care. 
• During labor, if a cesarean is suggested, press for more information with these questions:
  • Is my baby in any danger? Am I in any danger? If no, you have choices.
  • What are the risks and benefits of this intervention? All interventions have pros and cons. Watch out if you only hear the pros of Option A, and only the cons of Option B.
  • What does the research say? Not all medical practices are based on the best research.
  • Is there another alternative? There are many alternatives to common interventions, including waiting.

Lamaze urges women to be prepared to push for better care, and take a Lamaze childbirth education class. Learn more about Lamaze International's Six Healthy Birth Practices and what women can do to ensure the safest birth possible. Lamaze's Push for Your Baby campaign is designed to help women recognize common challenges faced in childbirth and share strategies for playing an active role in decision-making.