needed in many countries, and physicians are encouraged to actively lower the rate, as a caesarean rate higher than 10–15% is not associated with reductions in maternal or infant mortality rates, although some evidence support that a higher rate of 19% may result in better outcomes. Some of these efforts are: emphasizing a long latent phase of labor is not abnormal and not a justification for C-section; a new definition of the start of active labor from a cervical dilatation of 4 cm to a dilatation of 6 cm; and allowing women who have previously given birth to push for at least 2 hours, with 3 hours of pushing for women who have not previously given birth, before labor arrest is considered. Physical exercise during pregnancy decreases the risk. Additionally, results from a 2021 systematic review of the evidence on outpatient cervical ripening found that in women with low-risk pregnancies, the risk of cesarean delivery with harms to the mother or child were not significantly different than when done in an inpatient setting. Risks Adverse outcomes in low-risk pregnancies occur in 8.6% of vaginal deliveries and 9.2% of caesarean section deliveries. Mother In those who are low risk, the risk of death for caesarean sections is 13 per 100,000 vs. for vaginal birth 3.5 per 100,000 in the developed world. The United Kingdom National Health Service gives the risk of death for the mother as three times that of a vaginal birth. In Canada, the difference in serious morbidity or mortality for the mother (e.g. cardiac arrest, wound hematoma, or hysterectomy) was 1.8 additional cases per 100. The difference in in-hospital maternal death was not significant. A caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction), and wound infections. If a caesarean is performed in an emergency, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the risk of anaesthesia. Other risks include severe blood loss (which may require a blood transfusion) and post-dural-puncture spinal- headaches. Wound infections occur after caesarean sections at a rate of 3–15%. The presence of chorioamnionitis and obesity predisposes the woman to develop a surgical site infection. Women who had caesarean sections are more likely to have problems with later pregnancies, and women who want larger families should not seek an elective caesarean unless medical