Mount Carmel Doctor Discusses New C-Section Recommendations
By Misti Crane
The Columbus Dispatch - Sunday March 9, 2014 6:55 a.m.
Amanda McGonigle was tired. She was hungry. But she was determined.
The 26-year-old first-time mom from Delaware didn’t want her baby to arrive by Caesarean section if at all possible.
Four hours had passed since her labor had progressed — she was stuck at 7 centimeters and needed to get to 10. And it had been 13 hours since her water broke. Her obstetrician told her that surgery was a reasonable option.
“I really didn’t want to throw in the towel quite yet. It’s a harder recovery, and I was just really hoping to have a vaginal delivery,” said McGonigle, who, after some position changes and patience, welcomed Caroline about three hours later on Tuesday in an OhioHealth Riverside Methodist Hospital delivery room.
More moms likely will be sweating out longer labors under new guidelines that aim to prevent unnecessary C-sections. The recommendations redefine “active” labor and encourage obstetricians to avoid jumping to surgery if there’s no risk to mom or baby.
Among the guidance from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine:
Labor of more than 20 hours in first-time moms and 14 hours in others should not be a reason for a C-section.
Cervical dilation of 6 centimeters should be considered the start of active labor. In the past, 4 centimeters have been used.
There’s no specific maximum time for active labor.
Before determining that active labor has stalled, doctors should allow for at least three hours of pushing for first-time moms and two hours for others.
Vaginal delivery with the assistance of a vacuum or forceps should be considered an alternative to C-sections.
Before 41 weeks gestation, labor should generally be induced only in the interest of the baby’s or mother’s health.
Caesarean deliveries have increased rapidly in the past two decades to more than 30 percent nationally and in Ohio. First-time C-sections are of particular concern because they often lead to more C-sections and the associated risks (including infection) with subsequent children.
The primary reason for C-sections in first-time moms is stalled labor.
“We’ve seen a 60 percent increase (in Caesarean deliveries) since 1996,” said Dr. Stu Jones, Riverside’s chairman of obstetrics and gynecology.
He said he generally supports allowing longer labors, to avoid surgery. That’s good for the mom and keeps health-care costs down, he said. And giving pregnancy more time — a week past the full 40 — also makes sense, he said. “Mother Nature does a better job than we do in ... labor.
“This is kind of a bit of a culture shock to doctors,” Jones said of the new guidelines. “But if baby’s doing well, and mom has energy, maybe you give a little more time to push.”
Dr. Melissa Goist, an obstetrician at Ohio State University’s Wexner Medical Center, said she and many of her colleagues have been moving toward the updated guidelines for several years.
“I think it gives me as a physician more information to kind of reassure patients and to feel like waiting is not just torturing them,” she said.
The changes will take some time to become the norm, predicted Dr. Phillip Shubert, the director of maternal-fetal medicine for Mount Carmel Health System. “It’s like anything else. Cultural change doesn’t occur overnight.”
Doctors say many factors contribute to the rising C-section rate, including an increase in repeat C-sections in recent years and concerns about medical-malpractice lawsuits.
As she cradled 1-day-old Caroline last week, McGonigle said she was feeling great despite the many hours it took to bring her daughter into the world.
“I was tired. I had been up for like 30 hours at that point. It’s hard,” she said. “But I really just wanted to be able to do it myself if I could.”