Allowing most women with low-risk pregnancies to spend more time in the first stage of labor may avoid unnecessary cesareans, according to a joint guideline released by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.

“Evidence now shows that labor actually progresses slower than we thought in the past, so many women might just need a little more time to labor and deliver vaginally instead of moving to a cesarean delivery,” said Aaron B. Caughey, MD, a member of ACOG’s Committee on Obstetric Practice who helped develop the new recommendations. “Most women who have had a cesarean with their first baby end up having repeat cesarean deliveries for subsequent babies, and this is what we’re trying to avoid. By preventing the first cesarean delivery, we should be able to reduce the nation’s overall cesarean delivery rate.”

In 2011, one in three women in the US gave birth by cesarean delivery, a 60% increase since 1996. Today, approximately 60% of all cesarean deliveries occur among women with their first birth. According to ACOG, although cesarean deliveries can be life-saving for the baby and/or the mother, the rapid increase in cesarean birth rates raises significant concern that cesarean delivery is overused without clear evidence that it improves outcomes for the mothers or babies.

The new guidelines for preventing cesareans including:

• Allowing prolonged latent (early) phase labor.
• Considering cervical dilation of 6 cm (instead of 4 cm) as the start of active phase labor.
• Allowing more time for labor to progress in the active phase.
• Allowing women to push for at least two hours if they have delivered before, three hours if it’s their first delivery, and even longer in some situations, for example, with an epidural.
• Using techniques such as forceps to assist with vaginal delivery, when possible.
• Encouraging patients to avoid excessive weight gain during pregnancy.

“Physicians do need to balance risks and benefits, and for some clinical conditions, cesarean is definitely the best mode of delivery,” said Vincenzo Berghella, M.D., SMFM President, who helped develop the new recommendations. “But for most pregnancies that are low-risk, cesarean delivery may pose greater risk than vaginal delivery, especially risks related to future pregnancies.”