ACOG Recommends Doulas to Lower Primary Cesarean Rates

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The following is a student blog post by Angela Rooney

ACOG Recommends Doulas to Lower Primary Cesarean Rates

Cesarean
Cesarean

A new publication just released on February, 19, 2014  by the American Congress of Obstetrics and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) announces what a doula already knows!

The articles findings state that from 1996 to 2011 cesarean rates in the U.S. have increased rapidly without a decrease in maternal or fetal injuries or deaths.  This indicates that OB/GYNs have been over using the surgery on first time mothers in non-emergency instances.

In order to invoke change in the rising increase in primary cesareans, one must ask the reasons these surgeons are performing so many major surgeries to first time moms in the first place.

The top five reasons for a primary cesarean in order of greatest to least:

1.  Labor Dystocia

2.  Abnormal Fetal Heart Rate

3.  Malpresentation of the Fetus

4.  Multiple Gestation

5.  Fetal Macrosomia

 

The article then discusses safe measures that need to be taken to decrease the chance of resulting in a cesarean section.  These are not new techniques or guidelines, but we need to see them better implemented.

  1. Labor Dystocia:
    1.  Labor may be a slower process than previously defined and needs to be redefined.
    2. Defining active labor is strongly recommended to change from 4 to 6 centimeters.  Before 6 centimeters, actions for the active phase of labor should not apply.
    3. Physicians should be well trained in operative vaginal deliveries, such as vacuum and forcep delivery,  to utilize them as a safe alternative to cesareans.
  2. Abnormal Fetal Heart Rate:
    1. “Amnioinfusion for repetitive variable fetal heart rate decelerations may safely reduce the rate of cesarean delivery.”
    2. Scalp stimulation is an effective tool when the cervix is dilated to determine the fetal acid-base status.
  3. Malpresentation of the Fetus:
    1. Fetal presentation should be checked by 36 weeks in order to apply an external cephalic version.
  4. Multiple Gestation:
    1. Women with cephalic presenting twins or cephalic/ noncephalic  presented twins should be recommended to deliver vaginally.

5.  Fetal Macrosomia:

a. Ultrasounds are fairly inaccurate at estimating weight in later pregnancy.  Only mothers with estimated fetal weight over 5,000 g. without gestational diabetes or 4,500g. with gestational diabetes should be subject to a cesarean.

b. Women should be counseled on maternal weight gain, diet, and exercise guidelines.

 

The best part of the article comes at the end when it discusses the importance of continuous labor support.  Ahem ;-)

“Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery (111). Given that there are no associated measurable harms, this resource is probably underutilized.”

It’s not exactly a new concept that elective cesareans have been overused with 1/3 of U.S. mothers walking around with c-section scars.   Finally research findings are becoming mainstream, and hopefully, new guidelines can be put into effect.  Yes, sometimes a Cesarean is crucial to prevent maternal or fetal morbidity.   We must come together as birth professionals, doulas, midwives, nurses, and OB/GYNs alike, and respect the guidelines for our common end goal– a healthy and happy mother and baby.

 

You can read the full article here:

http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery

 

About the Author:

Angela Rooney has a BA in Psychology, is a professional birth doula, and is a Certified Pre/Postnatal Fitness Specialist.  She’s passionate about helping pregnant women have a memorable childbirth experience. Read more about Angela and her work at [www.mindandbodymama.com]. Follow her at [https://www.facebook.com/mindandbodymama] and [https://twitter.com/mindandbodymama].

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