The cesarean birth epidemic: Trends, causes, and solutions,☆☆,

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Abstract

We should anticipate a continued slow fall in cesarean birth rates over time as initiatives for health care improvement help us focus on strategies to avoid interference in the normal process of labor and vaginal birth. (Am J Obstet Gynecol 1996;175:369-74.)

Section snippets

TRENDS

Discharge data from short-stay, nonfederal hospitals have been collected annually by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Estimates of cesarean birth data are based on the National Hospital Discharge Survey annual reports. The total cesarean birth rate in 1970 was 5.5%, of which 4.2% were primary.1 These values peaked in 1988 with total and primary cesarean rates of 24.7% and 17.5%, respectively. The year 1993 showed a total cesarean birth

Repeat cesarean delivery

Fig. 2 succinctly depicts the causes of the escalation in the cesarean rate over two major time periods in the last two decades.10, 11 It is apparent that the practice of elective repeat cesarean delivery for patients with previous cesarean births has been the major contributor to the escalation in the total cesarean birth rate. The traditional belief in “once a cesarean always a cesarean” has been difficult to nullify; it was not until the mid 1980s that enthusiasm for vaginal birth after a

Clinical practice

The most important first step by any clinician or institution in reducing cesarean birth rates is a commitment to keep high quality statistics. If these data are not available, strategies to reduce cesarean births will be unsuccessful.

A number of clinical practices have been shown to diminish the cesarean birth rate. First among these is the management of patients with previous cesarean births. Patients with a single previous low transverse cesarean scar and no new indication for abdominal

COMMENT

Each individual obstetric service interested in curbing the escalating cesarean birth rate must address the specific causes as determined by analysis of their own data. Most services will find that the management of patients with previous cesarean scars and the approach of the medical and nursing staff to abnormal progress in nulliparous labor are important determinants of the cesarean birth rate. The impact of conduction anesthesia on primary cesarean delivery should not be overlooked. If the

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    From Columbia/HealthONE and the University of Coloradoaand St. Luke's Perinatal Center and the University of Missouri at Kansas City.b

    ☆☆

    Reprint requests: Richard P. Porreco, MD, Rocky Mountain Perinatal Associates, PC, 1601 E. 19th Ave., Suite 6500, Denver, CO 80218.

    0002-9378/96 $5.00 + 0 6/1/73864

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