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New Guidelines for C-Sections

The American College of Obstetricians and Gynecologists (ACOG) has issued new guidelines for cesarean births, commonly known as C-sections. Such births now make up 22% of all deliveries, but officials want to bring that number back down to 15%. CBS Medical Correspondent Emily Senay, MD, has the details.

Several factors, including slow labor, have increased the number of C-sections in the US. Previous studies have shown that women who have continual care from nurses or midwives get fewer C-sections than those who are cared for by busy nurses who check in on the patient every so often.

A woman's geographic location may also determine whether or not she will end up on the operating table. Research has shown that C-sections are more common in the South than in the West. More than one fourth of them happen in the states of Mississippi and Louisiana. Experts say the state-by-state variation suggests that doctors' habits may also overshadow medical need. Better regional anesthesia has also significantly diminished fears about the safety of C-sections.

C-sections can be life saving for many mothers and babies. Doctors say it should be considered only when there is fetal distress, if the baby is too big or wrongly positioned, or when there are disorders that make the labor risky for the mother or baby.

The risk of death for a woman undergoing a C-section is three to seven times higher than a woman who is giving a vaginal delivery. Women with C-sections also have increased pain, longer hospital stays and a higher risk of post-delivery infection.

The new guidelines on C-sections recommend that hospitals and physicians review and reduce their cesarean delivery rates where appropriate. Before giving a woman a C-section, doctors are asked to consider her C-section history, the pace of her labor, epidural injections and correcting the baby's position.

Experts say a C-section is the biggest risk factor for having another. If the surgical cut was in the lower abdomen as opposed to the upper abdomen, most healthy women can reportedly try vaginal delivery for their next baby as long as a surgeon is standing by for any necessary emergency surgery.

The guidelines caution against surgery too early when a woman is experiencing slow labor. They also warn against giving the painkilling epidural too early, before the cervix is dilated 4-5 centimeters. Officials say that increases a woman's C-section risk.

Doctors are also asked to consider trying to turn the baby headfirst by pushing onto the mother's abdomen before automatically operating.

Some obstetricians challenge the ACOG's idea of lowering C-sections to a 15% target rate. Critics say applying statistics to individual patients isn't good practice. The important thing, they say, is for 100% of the C-sections to be done when they're medically necessary and for none to be done when they're not.

To prevent the possibility of getting an unnecessary C-section, pregnant women are advised task about C-section rates. Experts say it's best to choose a hospital with a lower C-section rate and to pick a doctor who's open to a second opinion.

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