Indications Contributing to the Increasing Cesarean Delivery Rate

Abstract

OBJECTIVE To examine physician-documented indications for cesarean delivery in order to investigate the specific indications contributing to this increase. METHODS We analyzed rates of primary and repeat cesarean delivery, including indications for the procedure, among 32,443 live births at a major academic hospital between 2003–2009. Time trends for each indication were modeled to estimate the absolute and cumulative annualized relative risk of cesarean by indication over time and the relative contribution of each indication to the overall increase in primary cesarean delivery rate. RESULTS The cesarean delivery rate increased from 26% to 36.5% between 2003 and 2009; 50.0% of the increase was attributable to an increase in primary cesarean delivery. Among the documented indications, nonreassuring fetal status, arrest of dilation, multiple gestation, pre-eclampsia, suspected macrosomia, and maternal request increased over time, while arrest of descent, malpresentation, maternal-fetal indications, and other obstetric indications (eg, cord prolapse, placenta previa) did not increase. The relative contributions of each indication to the total increase in primary cesarean rate were: Non-reassuring fetal status (32%), labor arrest disorders (18%), multiple gestation (16%), suspected macrosomia (10%), pre-eclampsia (10%), maternal request (8%), maternal-fetal conditions (5%), and other obstetric conditions (1%). CONCLUSION Primary cesarean births accounted for 50% of the increasing cesarean rate. Among primary cesareans, more subjective indications (nonreassuring fetal status and arrest of dilation) contributed larger proportions than more objective indications (malpresentation, maternal-fetal, and obstetric conditions).

The association between the regular use of risk-based term IOL and improved birth outcomes in an Italian hospital: A retrospective cohort study

“…Possible reasons include the modern option of patient-choice CD, medicallegal pressures to deliver "un-injured" babies, and an increasing number of medical indications for CD [4][5][6]. As compared to 30 years ago, pregnant women in developed countries now tend to be older, heavier, and more likely to have medical conditions linked to CD [7][8][9].…”

Can the Rate of C-sections Performed in a Level I Perinatal Center Be Reduced? – An Analysis of the University Gynecology Clinic Rostock, 2008 – 2014

“…However, between 1997 and 2003, the rate of primary C-sections increased from 32.63 % (in 1997) to 48.23 % (in 2003), while the rate of secondary C-sections dropped correspondingly [24]. Other studies have also reported an increase in the number ▶ of primary C-sections and blamed it for the overall rise in C-sections [7,12]. It was therefore thought that lowering the rate of primary C-sections would be one way of decreasing the high rates of cesarean sections [25].…”

“…To explain their results, the authors referred to the increasing support of maternal choices by obstetricians, the lack of psychological counselling and the fact that pregnant women interpreted C-sections as a safer way of giving birth [28]. Elective C-sections have often been cited as one reason for the increasing rate of C-sections but, according to the results from a number of studies, this reason appears to be overestimated [7][8][9]42]. It has been surmised that, in fact, elective C-sections are rarely preferred, a surmise was supported by a survey of 534 pregnant women carried out at the University Gynecology Clinic Lübeck on their preferred mode of delivery.…”

“…These indications along with the increasingly older maternal age at pregnancy and maternal comorbidities are often discussed as possible factors for the increased incidence of C-sections [4][5][6]. Elective C-sections are also often cited as a reason [7][8][9][10]. The fear of legal consequences for birth defects and organizational reasons can also play a role [4,10,11].…”

Parenteral Nutrition in the Newborn: Associated Disorders and Nutritional Aspects

“…Performing of cesarean delivery have increased significantly over the years, about 37% of US births are performed this way [21]. When the procedure (i.e.…”