The cesarean birth epidemic: Trends, causes, and solutions☆,☆☆,★
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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Cited by (112)
Impact of Uterine Scar on Pain Experienced During Outpatient Hysteroscopy: A Prospective Blinded Comparative Study
2017, Journal of Minimally Invasive GynecologyImpact of a diagnosis-related group payment system on cesarean section in Korea
2016, Health PolicyCitation Excerpt :To minimize the confounding effects of differences across hospitals, we adjusted for patient volume per hospital. The Hirschmann–Herfindal Index (HHI) was included to reflect the different degrees of market competition [2,26]. Patient characteristics included patient ID, parity (primiparous, multiparous), age, and patient clinical complexity level (PCCL: 0, 1, 2, 3).
Mode of birth and social inequalities in health: The effect of maternal education and access to hospital care on cesarean delivery
2014, Health and PlaceCitation Excerpt :Instead, this trend can be explained by medical factors such as maternal or fetal indications. Factors influencing a cesarean birth are obesity, diabetes mellitus, the increased age of primiparous women, failure to progress during labor, fetal distress, malpresentation (such as breech presentation), and previous cesarean sections (Crane et al., 1997; Grivell and Dodd, 2011; Leitch and Walker, 1998; Porreco and Thorp, 1996). It is also possible that social factors lead to increased risks in obstetrics: women with lower social status are more likely to have an unhealthy diet, to smoke, and to have lower prenatal care participation (Goeckenjan et al., 2009; Günter et al., 2007; Lynch et al., 1997; Fingerhut et al., 1990; Wen et al., 2010).
A look into the past: Improves in obstetrical and neonatal outcome in maternity since the 19th century
2011, Journal de Gynecologie Obstetrique et Biologie de la ReproductionPublic–private differentials in health care delivery: the case of cesarean deliveries in Algeria
2021, International Journal of Health Economics and Management
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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
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Reprint requests: Richard P. Porreco, MD, Rocky Mountain Perinatal Associates, PC, 1601 E. 19th Ave., Suite 6500, Denver, CO 80218.
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0002-9378/96 $5.00 + 0 6/1/73864