Table 1 Guidelines for “compliant” cesarean deliveries

Failed induction of labor

Latent phase persists despite:

• Cervical ripening for Bishops score ≤ 6 cm

• At least 24 h in the latent phase (defined as from initiation of cervical ripening, pitocin started, or AROM [whichever came first] to time of delivery)

• At least 12 h of pitocin after rupture of membranes

Arrest of the first stage of labor

Cervix ≥6 cm and ruptured membranes with:

• No cervical change despite 4 h of adequate uterine contractions with IUPC and MVU > 200

Or

• No cervical change despite 6 h of inadequate uterine contractions with or without IUPC

Arrest of the second stage of labor

• Operative VD attempted for arrest and unsuccessful

Or

• At least 2 h of pushing in multiparous women

Or

• At least 3 h of pushing in nulliparous women

And

• If vertex is documented as malpositioned, manual rotation of fetal occiput must be attempted (only compliant for c/s if also pushed for the above durations)

Macrosomia

• Ultrasound estimated fetal weight ≥ 4500 g in women with diabetes

Or

• Ultrasound estimated fetal weight ≥ 5000 g in women without diabetes

Malpresentation

• External cephalic version attempted and failed

Or

• External cephalic version counseling documented and declined

Twin gestations

• Presenting twin is cephalic and patient counseled toward VD but opted for CD

Or

• Presenting twin is non-cephalic

Non-reassuring fetal heart tones

• Amnioinfusion prior to CD in the setting of variable decelerations

And/Or

• Scalp stimulation documented prior to CD in the setting of minimal or absent variability