[Pro and con the trend to an increasing frequency of cesarean sections]

The trend of increasing the CS rate is based on the improvement of skill and safety of operation, broadened and not well defined indications, some demographic, anthropological and social changes during recent decades. Most authors stress on the patient's will and on the role of nonclinical factors including the physician's training/experience, financial and convenience incentives. At the same time the increasing CS rate can not achieve the expectant medical benefits as abrupt decrease of prenatal mortality and morbidity, or intranatal trauma for the newborn and the women. Efforts to reduce unnecessary CS should focus on identifying the appropriate clinical indications for CS and spread this information to physicians. The trial to calculate the optimal rate of CS based on the prenatal mortality and morbidity, on the rate of the complication during pregnancy and labor requiring CS or the magnitude of delivery trauma nowadays is unsatisfactory. To compare the CS rate between countries or regions and draw conclusions from this is inadequate as many medical and nonclinical variables take place in the decision to perform cesarean delivery.