The dramatic rise in cesarean delivery (CD) rates worldwide in the recent past, without an evidence of a concomitant decrease in cerebral palsy rates, has raised concerns about its potential negative consequences on maternal and infant health.

The American Journal of Obstetrics and Gynecology recently published an Obstetric Care Consensus for safe prevention of the primary cesarean delivery. This retrospective cohort study aimed to assess whether modification of the existing protocol to implement these recommendations helped in decreasing the primary CD rate, safely.

This study included all women (3283 and 3068 women in the before and after periods, respectively) with singleton pregnancies at ≥ 37 weeks gestation, in vertex presentation, spontaneous or induced labor, and with epidural anesthesia. Maternal and neonatal outcomes over two 1-year periods: from March 2013 to February 2014 (before, preguideline) and from June 2014 to May 2015 (after, postguideline), were compared.

The results revealed that the modified protocol (with the new consensus recommendations) was associated with a reduction in the rate of primary CD performed for arrest of first-stage labor (AoL), with no apparent increase in immediate adverse neonatal outcomes in nulliparous women at term with singleton pregnancies in vertex presentation and with epidural anesthesia.