Recent reports of rising cesarean delivery rates in the United States are a significant concern, both to the public and to those of us who are practicing obstetrics. Cesarean delivery rates vary dramatically across geographic areas of the country but also from one neighboring hospital to the next.
Certainly the variations in cesarean delivery rates are multi-factorial. It is easy to understand if a tertiary care hospital receiving high-risk pregnancies from a broad referral area would have an elevated cesarean delivery rate. However, it is disturbing to see that some hospitals with a high percentage of low-risk deliveries have higher cesarean delivery rates than the tertiary care hospitals in their referral area.
ACOG and the Society for Maternal-Fetal Medicine released a consensus statement in March on Safe Prevention of the Primary Cesarean Delivery. The statement addresses multiple modifiable considerations to reduce the cesarean delivery rate. I suggest that every obstetrician carefully read this document, paying particular attention to the discussion of labor dystocia and labor arrest as the most common cause of primary cesarean delivery.
Simply stated, current evidence according to the Consortium on Safe Labor indicates the diagnosis of labor arrest should not strongly be considered until the cervix has reached 6 centimeters dilated in both primiparous and multiparous women. This is in contrast to the standards proposed by the Friedman curve that have been operational in most labor and delivery units.
Waiting, observing, having another cup of coffee, and even pacing the floor until the cervix reaches 6 cm dilated can make the difference between a vaginal delivery and a cesarean delivery. Normal labor can be a relatively slow process, but our patients do deserve our patience.
