Cesarean Delivery: Resource Overview

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.

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Resources for Ob-Gyns and Women’s Health Care Providers
Resources for Women and Patients
External Organizations

Resources for Ob-Gyns and Women’s Health Care Providers

Committee Opinion: Cesarean Delivery on Maternal Request

“Cesarean Delivery on Maternal Request,” issued by ACOG in January 2019, 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.  

Committee Opinion: Refusal of Medically Recommended Treatment During Pregnancy

“Refusal of Medically Recommended Treatment During Pregnancy,” issued by ACOG in June 2016, offers ob-gyns an ethical approach to addressing a pregnant woman’s decision to refuse recommended medical treatment.

Committee Opinion: Ethical Decision Making in Obstetrics and Gynecology

“Ethical Decision Making in Obstetrics and Gynecology,” issued by ACOG in December 2007, offers guidelines to aid practitioners in analyzing and resolving ethical problems.

Obstetric Care Consensus: Placenta Accreta Spectrum

“Placenta Accreta Spectrum,” issued jointly by the Society for Maternal-Fetal Medicine (SMFM) and ACOG in December 2018, provides guidelines for second-trimester termination and management of associated complications.

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.

Book of Guidelines: Guidelines for Perinatal Care (members only)

“Guidelines for Perinatal Care,” developed by the American Academy of Pediatrics Committee on Fetus and Newborn and issued by ACOG in September 2017, includes a section titled “Cesarean Delivery,” which 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: Labor and Delivery Management of Women With Human Immunodeficiency Virus Infection

"Labor and Delivery Management of Women With Human Immunodeficiency Virus Infection," issued by ACOG in September 2018, explains that prevention of transmission of HIV from the woman to her fetus or newborn is a major goal in the care of pregnancy women infected with HIV. It has been revised to provide updated guidance on the management of pregnant women during pregnancy and delivery to prevent mother-to-child transmission of the human immunodeficiency virus.

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 Cesarean Delivery,” issued by ACOG in February 2019, 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. 

Committee Opinion: Approaches to Limit Intervention During Labor and Birth

“Approaches to Limit Intervention During Labor and Birth,” issued by ACOG in February 2019, 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.

Committee Opinion: Vaginal Seeding

"Vaginal Seeding," issued by ACOG in November 2017, discusses the clinical considerations and risks associated with vaginal seeding, and emphasizes the need for additional research on the safety and benefits of the practice.

Resources for Women and Patients

Patient FAQ: Cesarean Birth (C-section)

“Cesarean Birth,” issued by ACOG in May 2018, 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 and Education Pamphlet: Vaginal Birth After Cesarean Delivery

“Vaginal Birth After Cesarean Delivery,” issued by ACOG in December 2017, 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. 

External Organizations

The World Health Organization statement on Cesarean Section Rates explains the concerns of rising rates for the procedure. 

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.

The American College of Obstetricians and Gynecologists (ACOG), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality women’s health care, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.

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