What are the ACOG/SMFM guidelines for prevention of cesarean delivery (C-section)?

Updated: Dec 14, 2018
  • Author: Hedwige Saint Louis, MD, MPH, FACOG; Chief Editor: Christine Isaacs, MD  more...
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The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released joint guidelines for the safe prevention of primary cesarean delivery. These include the following [5, 6] :

  • Prolonged latent (early)-phase labor should be permitted

  • The start of active-phase labor can be defined as cervical dilation of 6 cm, rather than 4 cm

  • In the active phase, more time should be permitted for labor to progress

  • Multiparous women should be allowed to push for 2 or more hours and primiparous women for 3 or more hours; pushing may be allowed to continue for even longer periods in some cases, as when epidural anesthesia is administered

  • Techniques to aid vaginal delivery, such as the use of forceps, should be employed

  • Patients should be encouraged to avoid excessive weight gain during pregnancy

  • Access to nonmedical interventions during labor, such as continuous support during labor and delivery, should be increased

  • External cephalic version should be performed for breech presentation

  • Women with twin gestations should, if the first twin is in cephalic presentation, be permitted a trial of labor

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