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A new document developed jointly by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine, aims to help lower cesarean delivery rates. According to the document, published concurrently in the March 2014 issue of the American Journal of Obstetrics and Gynecology, in 2011 alone a whopping one in three women who gave birth in the United States did so by cesarean delivery. In some cases, of course a cesarean birth is warranted and can even be life-saving for the baby(ies), the mother, or both. However, rates of cesarean births have gone up so quickly, that the figures are alarming. The National Institutes of Health recently commissioned evidence-based reports regarding c-section births over recent years to examine the risks and benefits of both cesarean and vaginal delivery and found that for most pregnancies that are low-risk, cesarean delivery poses a greater risk of maternal morbidity and mortality than vaginal delivery. Considering that rates of cesareans have risen at great speed from 1996 to 2011 without clear evidence that all were needed does raise significant concerns that cesarean delivery is far too overused in the United States.


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While c-sections have become almost a joke in this country, as in moms who state, “Screw childbirth, I’m getting a c-section,” this kind of delivery is no laughing matter. The document states, “A large population-based study from Canada found that the risk of severe maternal morbidities––defined as hemorrhage that requires hysterectomy or transfusion, uterine rupture, anesthetic complications, shock, cardiac arrest, acute renal failure, assisted ventilation, venous thromboembolism, major infection, or in-hospital wound disruption or hematoma––was increased threefold for cesarean delivery as compared with vaginal delivery.”

Vaginal birth, if you’re low risk and have no complications is a much safer choice than a c-section. Designed to benefit mothers and babies, but slanted at caregivers, this document outlines some important information for anyone who assists with labor or who delivers babies. The document offers a simple chart, Recommendations for the Safe Prevention of the Primary Cesarean Delivery, with extended advice on each section of the chart, such as how to manage first and second stages of labor, fetal heart monitoring, handling abnormally progressing labor, twins and more.

What this research means to moms:

The ACOG recommendations are written for caregivers, not moms, though the recommendations will benefit moms. Even if you’re a mama-to-be, not a caregiver, this is important information to know about so that you can be in charge of your own birth experience – at least as much as nature allows. However, you may find the ACOG document a bit dry and too science based for your taste, so here are some key tips:

  • Women who are low risk with no major complications should aim for a vaginal birth vs. c-section.
  • ACOG recommends providers seriously consider allowing a longer pushing stage (up to 3 hours), along with manual re-positioning of the baby if needed and a greater use of forceps or vacuum delivery vs. c-section when possible.
  •  Dr. Aaron Caughey, the chief of obstetrics and gynecology at Oregon Health Sciences University in Portland and lead author of the guidelines tells NPR that moms-to-be should not freak out thinking that labor may be longer under the new guidelines, but instead think about it in terms of preventing a c-section, which can result in more complications. Caughey also reminds moms that there is no “normal” labor time and not to rely too much on fetal heart rate monitors because no one understands heart monitors as a diagnostic tool very well and, “The incidence of a child being injured in the womb is pretty low, probably about 1 percent in a normal pregnancy.” Read more of what Dr. Aaron Caughey has to say.

+ Safe Prevention of the Primary Cesarean Delivery

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