Eunice Kennedy Schriver NICHHD Recommends Ways To Avoid a Cesarean Delivery

In a recent work shop there were two factors emphasized that will help women and their birth attendants avoid Cesarean birth: skills and patience. A third factor has been added: weight management. Since it is one of the most commonly performed surgeries in the US, accounting for a million operative procedures on women in the USA each year, avoiding this surgery is still a goal for obstetrical providers of care. In 2010 the Health People act aimed at 15% rate of Cesarean Birth, but we have over a 30% rate and climbing. So the goal, as reported in a recent workshop report seen in the journal Obstetrics and Gynecology, is to get that rate to 23.9% which would lower our rate down to what it was in the first decade of this century. Staying home also keeps the shortest labor possible, and there is some thought that will even make it less likely to have a c-section. For first timers, if you hit the hospital it is several hours before you birth. Once you actually hit 6 cm dilated, it only takes 2 hours to be ready to push in most first timers, and only 1.5 hours to get to that point if you have had a baby before. Avoiding inductions when possible, and making sure the cervix is ripe enough for an induction was targeted as a possible way to reduce Cesarean birth. How to define the ripe cervix was debated, but if your Bishops score (your gyno can define, but this score is achieved by points for how open the cervix is, how thin it is, etc) of 8 has then the same risk of winding up with a c-section as does going into labor spontaneously. Obstetricians define stalled labors in a number of ways, and we've set time limits on the sequence of normal. But some women can safely progress a lot more slowly. Baby's and mom's health can be monitored closely, and if both are healthy, don't make that clock tick quite so fast, but a bit more patience in the early stages of labor would avoid some c-sections. Although most women will progress much more quickly, even if you have had a prior baby, taking 3 hours to dilate each centimeter can be normal and not time to throw the towel in. It is also true that skilled use of forceps and vacuum can help patients deliver. The trend towards more obese moms has been driving up c-section rates. Normalizing your weight before pregnancy, keeping weight gains to recommended levels also decreased c-sections. A study from the NIH shows that for each BMI the rate of c-sections goes up. The reason was always assumed that the baby just wouldn't fit, but new data shows that women who are obese don't contract as well. So they have some of these slower cervical progressions, that may still allow for vaginal delivery if we go back to the first two principals skills and patience to help women avoid a c-section


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