Yesterday, I was talking to one of the moms who came to us for her first check up in this pregnancy, and she said something to me that blew my mind away. She told me that in her last pregnancy, she set into labor, and that her bag of waters broke after a few hours of labor. Contractions were coming a bit faster, but still very manageable. Then comes the nurse and hooks her onto the continuous EFM machine. The baby is doing fine. But, at the peak of the contraction, the baby’s heartbeat in around 130-135 bpm, as compared to 140-150 bpm without contractions. She is looking at the monitor, she feels fine, her baby is moving well. But, the doctor says that these are early decelerations, this is fetal distress – so she is advised a C-section immediately!! This time, she wants to try for a normal delivery. As I counsel her, I find it hard to believe that 130s heartbeat is thought of a deceleration, and just not as a normal response of the baby during a contraction! How much evidence based practice do routine hospitals use in maternity care?

With the tremendous increase in Cesarean rates over the last few years, the American College of Obsetricians and Gynecologists and the Society for Maternal Fetal Medicine issued a joint Obsetric Care Consensus statement on the Safe Prevention of the Primary Cesarean Section. This statement provides fantastic guidelines in the way maternity care should be delivered, and in the way hospitals and doctors should look at progression of labor, electronic fetal monitoring, breech presentations and twin pregnancies. All of this, in an effort to reduce that first C-section!

The Consensus Statement first establishes that vaginal birth in most cases is less risky and more beneficial for most mothers and their babies: “Childbirth by its very nature carries potential risks for the woman and her baby, regardless of the route of delivery. The National Institutes of Health has commissioned evidence-based reports over recent years to examine the risks and benefits of cesarean and vaginal delivery. For certain clinical conditions––such as placenta previa or uterine rupture––cesarean delivery is firmly established as the safest route of delivery. However, for most pregnancies, which are low-risk, cesarean delivery appears to pose greater risk of maternal morbidity and mortality than vaginal delivery.