With 1 in 3 births via cesarean—up 60% since 1996—leading experts are calling on healthcare providers and pregnant women alike strive to avoid unnecessary cesarean, particularly with first births.

“Evidence now shows that labor actually progresses slower than we thought in the past, so many women might just need a little more time to labor and deliver vaginally instead of moving to a cesarean,” said Aaron B. Caughey, MD, a member of the American College of Obstetricians and Gynecologists’ obstetric practice committee, which issued the national call to help reduce primary cesarean births along with the Society for Maternal-Fetal Medicine (SMFM).



“Most women who have had a cesarean with their first baby end up having repeat cesarean deliveries for subsequent babies, and this is what we’re trying to avoid. By preventing the first cesarean delivery, we should be able to reduce the nation’s overall cesarean delivery rate,” Caughey said.

The two medical organizations agree that the rapid increase in cesarean birth rates shows that cesarean happens far more often than it should, especially since it increases risks for moms and babies, and the increase in cesareans hasn’t led to healthier results for moms and babies.



Cesarean birth can be life-saving for a baby or mother in need, but this updated advice underscores that when all is healthy and well, you should:

  • Avoid choosing to induce labor or birth via cesarean without a medical reason
  • Wait for labor to start on its own
  • Labor longer, as needed, before pushing
  • Be given more time for pushing, as needed

If you’re pregnant now these means your healthcare provider is being asked to support you in laboring longer if all is going well, recognize that 6 cm dilation of your cervix is when active labor actually begins, and that you should be given more time to push during this phase, as needed.

If you’ve had a baby before, you should be allowed to push for at least 2 hours more than previously thought; 3 hours more if this is your first birth. For women who receive an epidural—which can slow labor—the advice is to push during this labor stage even longer if needed.

It all comes down to balancing risk and benefits, and in some cases, cesarean may be needed, said Vincenzo Berghella, MD, SMFM President, who helped develop the new recommendations. “But for most pregnancies that are low-risk, cesarean delivery may pose greater risk than vaginal delivery, especially risks related to future pregnancies.”



  • Only 5% of babies are born on their due date
  • Most babies will be born between 40 and 41 weeks if moms wait for labor to start on its own, especially first-time moms
  • You’re more likely to breastfeed and bond faster and for longer skin-to-skin through normal labor and birth, as well as reduce your risks for the “baby blues
  • Benefits of normal birth also include shorter hospital stays, lower infection rates and a faster recovery. You also reduce your baby’s risks for breathing problems through normal birth

wait for labor
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