Dr. Dwight Rouse addresses rapid increase in cesarean birth rates

March 06, 2014

In 2011, one in three pregnant women in the U.S. delivered babies by cesarean delivery. While cesarean delivery may be life-saving for the mother, the baby or both, the rapid increase in cesarean birth rates since 1996 without clear indication raises concerns that this type of delivery may be overused.

Dwight J. Rouse, MD, MSPH, a specialist in the Division of Maternal-Fetal Medicine at Women & Infants Hospital of Rhode Island and a professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University, has co-authored the first in a new, joint series called "Obstetric Care Consensus" that is being introduced by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM).

This inaugural issue, "Safe Prevention of the Primary Cesarean Delivery," addresses the rapid increase in cesarean birth rates and outlines a multifaceted approach that addresses indications for primary cesarean delivery.

"There is no doubt that there is a time and a place for a cesarean delivery. But we need to be sure that, as part of general obstetric practice, we are not overusing this tool for fear or convenience, particularly primary cesarean delivery," said Dr. Rouse. "It is important for health care providers to understand the short-term and long-term risks and benefits of cesarean and vaginal delivery, as well as safe and appropriate opportunities to prevent overuse of cesarean delivery."

This consensus outlines a multifaceted approach that addresses indications for primary cesarean delivery, including labor dystocia (abnormal or difficult labor), abnormal or indeterminate (formerly referred to as "nonreassuring") fetal heart rate tracing, fetal malpresentation (not head down in the birth canal), multiple gestation, and suspected fetal macrosomia (very large baby).

Dr. Rouse continued, "Childbirth, by its very nature, carries potential risks for a woman and her baby, regardless of the delivery method. We are hopeful that this information will offer obstetric providers guidelines to ensure the safest delivery possible for all women."
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About Women & Infants Hospital

Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women's medicine, Women & Infants is the eighth largest stand-alone obstetrical service in the country with nearly 8,400 deliveries per year. In 2009, Women & Infants opened the country's largest, single-family room neonatal intensive care unit.

New England's premier hospital for women and newborns, Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation's only mother-baby perinatal psychiatric partial hospital, as well as the nation's only fellowship program in obstetric medicine.Women & Infants has been designated as a Breast Center of Excellence from the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center for In Vitro Maturation Excellence by SAGE In Vitro Fertilization; a Center of Biomedical Research Excellence by the National Institutes of Health; and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute's Gynecologic Oncology Group and the National Institutes of Health's Pelvic Floor Disorders Network.

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