Safe Prevention of the Primary Cesarean Delivery

In response to concerns that cesarean delivery may be overused.

The American College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine has Published Guidelines

First stage of labor

  • Cervical dilation of 6 cm should be considered the threshold for the active phase of most women in labor. Thus, before 6 cm of dilation is achieved, standards of active phase progress should not be applied.
  • Cesarean delivery for active phase arrest in the first stage of labor should be reserved for women at or beyond 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change.

Second stage of labor

Before diagnosing arrest of labor in the second stage, if the maternal and fetal conditions permit, allow for the following:

  • At least 2 hours of pushing in multiparous women
  • At least 3 hours of pushing in nulliparous women

Longer durations may be appropriate on an individualized basis (eg, with the use of epidural analgesia or with fetal malposition) as long as progress is being documented.


US Cesarean Section Rate

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