Obstetricians Target Primary Cesarean Delivery Rate
Definition of labor dystocia may need revising; nonmedical interventions in labor can cut rates
MONDAY, Feb. 24, 2014 (HealthDay News) -- Primary cesarean delivery rates can be safely reduced by implementing various interventions, according to a consensus statement published online in the March issue of Obstetrics & Gynecology.
Aaron B. Caughey, M.D., Ph.D., and colleagues from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine discuss safe reduction in the rate of primary cesarean delivery. According to the authors, in 2011, one in three women who gave birth in the United States did so by cesarean delivery.
The authors note that the most common indications for primary cesarean delivery include labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia, with distinct approaches needed to safely reduce cesarean delivery for each indication. For example, definitions of labor dystonia may need revising in light of recent data which suggest that labor progresses at a substantially slower rate than previously thought. Improved and standardized interpretation and management of fetal heart rate may also have an effect. Cesarean birth rates can be reduced by increasing access to nonmedical interventions during labor, such as continuous labor and delivery support. Other examples of interventions include external cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation.
"Individuals, organizations, and governing bodies should work to ensure that research is conducted to provide a better knowledge base to guide decisions regarding cesarean delivery and to encourage policy changes that safely lower the rate of primary cesarean delivery," the authors write.