Practice Guidelines

Safe Reduction of Primary Cesarean Births: National Partnership for Maternal Safety Releases Consensus Bundle


Am Fam Physician. 2018 Aug 15;98(4):258-259.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Health systems should ensure that staff know the value of attaining vaginal birth and acknowledge patient desires.

• Every facility should implement standard admissions criteria for women who present in spontaneous labor.

• Diagnosis and treatment of dystocia are crucial to prevent unnecessary cesarean births.

From the AFP Editors

Unnecessary cesarean birth is a preventable cause of maternal morbidity and mortality. It can cause short-term complications such as blood loss, infection, and venous thrombosis, and long-term effects in subsequent pregnancies, including abnormal placentation, increased risk of hemorrhage, and hysterectomy. Because of a high cesarean birth rate in the United States (one in three women), it is a significant maternal health safety issue. A workgroup was appointed to address this issue and is made up of members who represent women's health care organizations, including the American Academy of Family Physicians, the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists, the Association of Women's Health, Obstetric and Neonatal Nurses, and consumers through the National Partnership for Women and Families.

The National Partnership for Maternal Safety has developed a patient safety bundle that outlines important practices that every maternity unit should implement to reduce the number of primary cesarean births and improve care to increase the number of vaginal births. The bundle consists of four domains: readiness, recognition and prevention, response, and reporting and systems learning. These components can be adapted to accommodate different facilities, but standardization within the facility is recommended.


Developing a culture that supports vaginal birth, as well as articulating the risks and benefits of a cesarean vs. vaginal birth, is one component of readiness. Health systems should ensure that staff know the value of attaining vaginal birth and acknowledge patient

AFP Editorial Coordinator

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



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