Preventing First Cesareans

We are starting a new blog post series for new moms, discussing issues that come up during the first few years of becoming a mom. First up is a blog post about avoiding cesareans during giving birth. 

Recently Released Guidelines that You Can Discuss with Your Doctor or Midwife

By Choices in Childbirth

Many expectant moms are concerned about the high rate of cesareans today, and the concern isn’t unfounded. One in three U.S. moms give birth via cesarean and yet this is not improving outcomes for women or babies. C-sections can be lifesaving when they are needed, but when used without medical reason, the risks can outweigh the benefits.

So knowing this information, what can expecting moms do to try and prevent a primary cesarean, and why do we distinguish “primary”?

Last year, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released guidelines aimed at safely preventing primary cesareans. When implemented, these guidelines could improve the quality and experience of maternity care across the country. The reason that preventing a primary cesarean is so important is because a woman’s risk of delivering via cesarean in future pregnancies goes up considerably if she’s had a primary cesarean. If she can prevent that first one, a mother will likely not need one in the future.

All of the recommendations can be found in the full report, but Choices in Childbirth authored a policy brief last fall that lists several factors for parents to think about now.

ACOG & SMFM’s Recommendations on Safely Preventing Initial Cesareans

  1. Women may need more time: Labor that is slow but progressing should NOT be considered an indication for cesarean. The active phase of labor begins at 6 cm dilation, not 4 as was previously thought.
  2. There should be no specific time limit for the pushing phase of labor as long as mom and baby are both doing well. At least 3 hours of pushing for first births should be considered normal, and the use of an epidural adds an hour to this suggested time frame.
  3. Forceps and vacuum-assisted vaginal delivery by an experienced doctor are safe, acceptable alternatives to cesarean.
  4. Before 41 weeks of pregnancy, it is not recommended to use medication to induce labor without medical reason.
  5. Variations in a baby’s heart rate are not always dangerous. They are often normal and temporary. Steps should be taken to try and improve a baby’s heart rate before a cesarean is recommended: changing a mother’s position, stimulating the baby’s scalp, or introducing sterile saline solution into the uterus to improve the baby’s environment.
  6. If a baby is breech, a physician can try turning the baby before labor begins.
  7. Twins do not always require a cesarean. If the first twin is head down, women should be encouraged to plan a vaginal delivery.
  8. Having a “big” baby is rarely a reason for cesarean. Unless the baby is believed to weight 11 lbs or more (or 9.9 lb or more for a mom with diabetes) vaginal birth is recommended. Ultrasound in the last few weeks of pregnancy is not a reliable method for predicting a baby’s size.
  9. Doula support reduces cesarean rates. The guidelines recommend that continuous labor support, such as support provided by doulas, is one of the most effective ways to decrease the cesarean rate and improve patient satisfaction. The ACOG/SMFM report found that doula support is underutilized.

About Choices in Childbirth

Choices in Childbirth is a non-profit organization dedicated to providing expectant parents with a full range of information and education so they can experience the birth they want and choose. We educate, advocate and shape policy to help families make informed decisions about where, how, and with whom to birth and to increase access to childbirth services that support healthy birth outcomes. Read more at