If we look at childbirth from the point of view of a game, the success or failure would be measured by the cesarean rate. When there is a 30% or higher rate of cesarean for first time mothers, there can be no excuse. . . those people playing the game are losing and losing badly. When there can be no denying that something is terribly wrong, what happens? The players get together and try to figure out what can be done to get a winning outcome. This has been done before by medical people with good results when action resulted. Unfortunately for women, it seems to be impossible to maintain positive results once the initial action plan is withdrawn. See my post.
There have been many statements, pledges, admonitions, expressions of concern, etc in the past 10 years about the impact on women’s health of all these major abdominal surgeries. See:
Cesareans Are Seriously Harming Women
Now we have a new statement put out by a team of people who are duly concerned in the USA. It mirrors other team reports. How many teams have to be gathered and how many over-educated people have to produce reports before a concerted program is instituted to stop the cesarean butchery of women in North America? We need action and we need it fast. Gloria Lemay, Feb. 12, 2014
Experts Identify Key to Reducing Cesarean Delivery Rate
News | February 05, 2014 | Pregnancy and Birth
By OBGYN.net Staff
Continued education on reducing unnecessary cesarean deliveries must include particular attention to preventing the first cesarean delivery, as well as tapping into the clinician’s ability to modify and mitigate factors that often contribute to the cesarean, leading experts suggested.
The article in which these suggestions are published is based on a workshop aimed at preventing first cesarean delivery.1 The workshop was a joint effort of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists.
“Given the risks associated with the initial cesarean and its implications in subsequent pregnancies, the most effective approach to reducing overall morbidities related to cesarean delivery is to avoid the first cesarean,” said George R. Saade, MD, of the division of maternal-fetal medicine, department of obstetrics and gynecology, University of Texas Medical Branch, Galveston and chair of the Society for Maternal-Fetal Medicine’s health policy committee. “The implications of a cesarean rate of 30% or more—since approximately 1 in 3 pregnancies are delivered by cesarean—have significant effects on the medical system as well as on the health of women and children. It is essential to embrace this concern and provide guidance on strategies to lower the primary cesarean rate.”
In 1995, the total rate of cesarean deliveries was 20.8%, and the rate of primary cesarean deliveries was 15.5%.2 The rise in the rate of cesarean delivery compared with these 1995 rates is due in part to an increase in the frequency of primary cesareans, the authors noted, but it is also because attempts at labor after cesarean have declined.
Workshop participants developed a set of guidelines for preventing first cesarean delivery. They included the appropriate ways to identify failed induction, arrest of labor progress, and non-reassuring fetal status. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed, as long as the maternal and fetal conditions permit, they noted. The experts also determined that the adequate time for each stage appears to be longer than traditionally thought.
Other key points included:
Accepting operative vaginal delivery as a birth method when indicated. Given its declining use, training and experience in operative vaginal delivery must be facilitated and encouraged.
Counseling pregnant women about the effect of cesarean delivery on future reproductive health.
If cesarean deliveries are conducted for non-medical indications, the gestational age should be at least 39 weeks and the cervix should be favorable, especially in the nulliparous patient.
The complete study is available here.
1. Spong CY, Berghella V, Wenstrom KD, et al. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists workshop. Accessed January 31, 2013. Available here.
2. Curtin SC, Kozak LJ. Cesarean delivery rates in 1995 continue to decline in the United States. Birth. 1997;24:194-196.