NORFOLK -- Two major medical groups, who represent America's obstetricians/gynecologists, issued guidelines last week aimed at curbing the overuse of cesarean sections for first-time mothers.
The American College of Obstetricians and Gynecologists reports about one-third of American women gave birth by C-section in 2011, a 60 percent rise since 1996. And the doctors' group said that women having their first child account for about 60 percent of all cesarean deliveries in the United States.
Among the guidelines:
- First-time mothers with low-risk pregnancies should be allowed to have more time in labor, to help lower their risk of having an unnecessary cesarean delivery.
- Active labor should be considered to begin at a cervical dilation of 6 centimeters, rather than the previous 4 centimeters.
- Women should be allowed to push for at least two hours if they've given birth before, three hours if they are first-time mothers, and even longer in certain cases, such as when an epidural is used for pain relief.
- Vaginal delivery is the preferred option whenever possible and doctors should use techniques -- forceps, for example -- to assist with natural birth.
- Women should be advised to avoid excessive weight gain during pregnancy.
Dr. Ted Hughes is an OB-GYN specialist at the Womancare Centers in Norfolk and says his office has the lowest cesarean rate in the area because they allow women at least three hours of labor before deciding to have a C-section.
Hughes says many doctors want to leave work on time and like the luxury of planning a birth as much as mothers do. He gives the example of a military family who tries to schedule a birth before the father leaves for Afghanistan. He says while he still considers the option for families in the situation, he tries to counsel them against it.
Hughes also credits midwives and doulas who work in his office for keeping the rate of C-sections down.
Doulas say that they like teach women what 'real labor' is by teaching them the signs of when they truly need to go to the hospital.
Doula Sarabeth Roberts says that many times changing the position during labor will help speed up the dilation of the cervix, which is usually what takes a while for first-time mothers.
Dr. Laurie DeGrand is a Womanscare Center specialist and a pregnant mother of a two-year-old. She is using a doula from Birth Insight in Norfolk and hopes to have a vaginal birth after having a C-section with her first child.
DeGrand is currently learning different techniques from a doula to have a healthier pregnancy this time, which she hopes will prevent the need for another C-section.
DeGrand says reading the new guidelines makes her feel like her wishes to have a vaginal birth will be medically supported.
Hughes explains that the guidelines could take years before they become standard of care. He says it's still important for the patient and the physician to have an honest conversation about the patient's situation.
Hughes says there are many situations where the babies heart rate is an important factor in determining whether a C-section is warranted and stresses that every patient is unique.