Safe prevention of the primary cesarean delivery This document was developed jointly by the with the assistance of

Aaron Caughey, Alison G. Cahill, Jeanne-Marie Guise, Dwight J. Rouse

Research output: Contribution to journalArticle

327 Citations (Scopus)

Abstract

In 2011, 1 in 3 women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be lifesaving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 through 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. Increasing women's access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate.

Original languageEnglish (US)
Pages (from-to)179-193
Number of pages15
JournalAmerican Journal of Obstetrics and Gynecology
Volume210
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

Fingerprint

Primary Prevention
Parturition
Dystocia
Fetal Heart Rate
Birth Rate
Fetal Version
Labor Presentation
Fetal Macrosomia
Trial of Labor
Mothers
Physicians' Practice Patterns
Breech Presentation
Pregnancy
Fetus
Head
Morbidity
Mortality

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Safe prevention of the primary cesarean delivery This document was developed jointly by the with the assistance of. / Caughey, Aaron; Cahill, Alison G.; Guise, Jeanne-Marie; Rouse, Dwight J.

In: American Journal of Obstetrics and Gynecology, Vol. 210, No. 3, 03.2014, p. 179-193.

Research output: Contribution to journalArticle

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