A cesarean birth, often called a C-section, is the delivery of the baby through incisions in the mother’s abdomen and uterus. Cesarean deliveries, whether elective or medically necessary, have risen dramatically in recent decades in the United States, making evidence-based research on methods, postoperative care, and how to safely reduce their incidence all the more imperative. Ob-gyns, physicians whose primary responsibility is women’s health, are best suited to help women determine whether cesarean delivery is appropriate for their pregnancy.
Here are the key publications and resources for ob-gyns, other women’s health care providers, and patients from the American College of Obstetricians and Gynecologists (ACOG) and other sources.
Resources for Ob-Gyns and Women’s Health Care Providers
Resources for Women and Patients
Resources for Ob-Gyns and Women’s Health Care Providers
Obstetric Care Consensus: Safe Prevention of the Primary Cesarean Delivery
“Safe Prevention of the Primary Cesarean Delivery,” issued jointly by the Society for Maternal-Fetal Medicine (SMFM) and ACOG in March 2014 (reaffirmed 2016), presents data on the increase of primary cesarean deliveries in the United States, as well as approaches in specific circumstances to safely reduce the rate of this procedure. It includes national and state-by-state data, maternal and neonatal risks and benefits, indications for primary cesarean deliveries, and the challenges in changing cultural and professional attitudes.
Committee Opinion: Cesarean Delivery on Maternal Request
“Cesarean Delivery on Maternal Request,” issued by ACOG in April 2013 (reaffirmed 2015), offers evidence-based guidelines for primary prelabor cesarean delivery on maternal request. It provides research on risks to both mother and child, physical and psychological factors in decision making, and topics for patient counseling. In the absence of maternal or fetal indications for cesarean delivery, the Committee Opinion states, a plan for vaginal delivery is safe and appropriate and should be recommended to patients.
Book of Guidelines: Guidelines for Perinatal Care (members only)
“Guidelines for Perinatal Care,” a 599-page publication developed by the American Academy of Pediatrics Committee on Fetus and Newborn and issued by ACOG in October 2012, includes a section titled “Cesarean Delivery,” starting on page 192. It provides clinical guidelines for hospitals and physicians performing emergency and elective cesarean deliveries.
Patient Safety Checklist: Preoperative Planned Cesarean Checklist
“Preoperative Planned Cesarean Checklist,” issue by ACOG in December 2011, is a preoperative patient safety checklist that includes medical history relevant to planned cesarean delivery. It is to be completed by the health care provider during the patient’s admission to the hospital.
Patient Safety Checklist: Scheduling Planned Cesarean Delivery
“Scheduling Planned Cesarean Delivery,” issued by ACOG in December 2011, is a patient safety checklist that includes relevant medical history and topics to be discussed prior to scheduling a planned cesarean delivery. The form is to be completed by the patient’s health care provider and submitted to the respective hospital, which can then review the appropriateness of the scheduling based on the information contained on the checklist.
Practice Bulletin: External Cephalic Version
“External Cephalic Version,” issued by ACOG in February 2016, explains the use of ECV as a means of reducing cesarean deliveries, particularly in the case of breech presentation. Because there is a low risk of adverse events as a result of ECV, women who are near term with breech presentations should be offered an ECV attempt if there are no contraindications.
Practice Bulletin: Management of Late-Term and Postterm Pregnancies
“Management of Late-Term and Postterm Pregnancies,” issued by ACOG in August 2014, explains that late-term and postterm pregnancies are associated with an increased risk of perinatal morbidity and mortality, and recommends induction of labor after 42 0/7 weeks and by 42 6/7 weeks of gestation.
Committee Opinion: Analgesia and Cesarean Delivery Rates
“Analgesia and Cesarean Delivery Rates,” issued by ACOG in June 2006 (reaffirmed 2016), explains that according to recent studies, the initiation of early neuraxial analgesia does not increase the risk of cesarean delivery, compared with intravenous systemic opioid analgesia. It states that in the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor.
Committee Opinion: Scheduled Cesarean Delivery and the Prevention of Vertical Transmission of HIV Infection
“Scheduled Cesarean Delivery and the Prevention of Vertical Transmission of HIV Infection,” issued by ACOG in May 2000 (reaffirmed 2015), explains that research suggests that a substantial number of cases of vertical transmission of HIV occur as the result of fetal exposure to the virus during labor and delivery, though the precise mechanisms are not known. Cesarean delivery performed before the onset of labor and rupture of membranes effectively reduces the risk of vertical transmission of HIV infection.
Committee Opinion: Tubal Ligation with Cesarean Delivery
“Tubal Ligation with Cesarean Delivery,” issued by ACOG in August 1998, explains that tubal ligation at the time of cesarean delivery requires significant additional physician work even though the technical work of the procedure is brief. Informed consent by the patient requires considerably more counseling regarding risks and benefits of this procedure than is necessary with alternative means of sterilization and contraception.
Practice Bulletin: Vaginal Birth After Previous Cesarean Delivery
“Vaginal Birth After Previous Cesarean Delivery,” issued by ACOG in August 2010 (reaffirmed 2015), explains that trial of labor after previous cesarean delivery (TOLAC) provides women who desire a vaginal delivery with the possibility of achieving that goal—a vaginal birth after cesarean delivery (VBAC). It states that most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered TOLAC.
Patient Safety Checklist: Appropriateness of Trial of Labor after Previous Cesarean Delivery (Antepartum Period)
“Appropriateness of Trial of Labor after Previous Cesarean Delivery (Antepartum Period),” issued by ACOG in November 2012, is a patient safety checklist that includes topics the patient should be counseled on prior to TOLAC. It should be completed by the provider early in the course of prenatal care for patients for whom TOLAC may be appropriate.
Patient Safety Checklist: Trial of Labor After Previous Cesarean Delivery (Intrapartum Admission)
“Trial of Labor After Previous Cesarean Delivery (Intrapartum Admission),” issued by ACOG in November 2012, is a patient safety checklist to be completed by the provider when a patient undergoing TOLAC is admitted to Labor and Delivery.
Committee Opinion: Approaches to Limit Intervention During Labor and Birth
“Approaches to Limit Intervention During Labor and Birth,” issued by ACOG in February 2017, recognizes that the desire to avoid unnecessary interventions during labor is shared by health care providers and pregnant women, and reviews labor care practices that minimize intervention for appropriate women who are in spontaneous labor at term.
Deliveries Before 39 Weeks
"Deliveries Before 39 Weeks" explains that elective deliveries before 39 completed weeks of gestation can pose both short-term and long-term health risks for the newborn. This ACOG department page offers resources and links to other national and provider efforts to help reduce unnecessary deliveries prior to 39 completed weeks.
Resources for Women and Patients
Patient FAQ: Cesarean Birth (C-section)
“Cesarean Birth (C-section),” issued by ACOG in May 2015, is a list of questions and answers for the patient relating to cesarean birth, including a description of the procedure, reasons for cesarean delivery, potential complications, and what to expect after a cesarean.
Patient FAQ: Elective Delivery Before 39 Weeks
“Elective Delivery Before 39 Weeks,” issued by ACOG in June 2013, is a list of questions and answers for the patient explaining issues surrounding elective delivery before 39 weeks. It covers such topics as medically indicated delivery, length and development of normal pregnancy, potential health problems for babies born too early, and risks of induced labor.
Patient FAQ and Education Pamphlet: Vaginal Birth After Cesarean Delivery: Deciding on a Trial of Labor After Cesarean Delivery
“Vaginal Birth After Cesarean Delivery: Deciding on a Trial of Labor After Cesarean Delivery,” issued by ACOG in August 2011, explains that many women can undergo a trial of labor after a cesarean delivery (TOLAC), and will subsequently be able to give birth through the vagina (called a vaginal birth after cesarean delivery, or VBAC). It lists reasons a woman may want to consider TOLAC as a delivery option, as well as the risks involved.
The Society for Maternal-Fetal Medicine is an organization that offers physicians and scientists a place to share knowledge, research, and clinical best practices with the goal of improving care for mothers and their babies. Its website includes links to articles, guidelines, and scientific studies covering various issues related to cesarean sections.
The California Maternal Quality Care Collaborative (CMQCC) has developed a toolkit designed to educate maternity teams, apply best practices for supporting vaginal births, and reduce unnecessary cesarean section births.