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Reversing the upward trend in the cesarean section rate
Summary
This study reversed an increasing cesarean section rate by implementing new protocols, reducing the rate from 12% to 9.7%. Key changes included managing breech births and allowing more trial of labor after cesarean, without affecting fetal mortality.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Public Health
Background:
- Cesarean section rates have been increasing globally.
- Variations in cesarean section rates exist between institutions.
- Understanding trends and indications is crucial for clinical practice.
Purpose of the Study:
- To analyze trends in cesarean section indications over 20 years.
- To evaluate the impact of a revised approach to cesarean sections.
- To identify strategies for reducing cesarean section rates.
Main Methods:
- Retrospective analysis of cesarean section data from 1981 onwards.
- Implementation of interventions to decrease cesarean rates, including external cephalic version and trials of labor after cesarean.
- Monitoring of primary and repeat cesarean section rates and indications.
Main Results:
- The overall cesarean section rate was reversed, decreasing from a plateau of 12% to 9.7% by 1985.
- Significant reduction in cesarean sections for breech presentation (1.2% vs. 2.8%) due to increased external cephalic versions.
- Decrease in repeat cesarean sections (2.6% vs. 3.7%) attributed to allowing more trials of labor after prior cesarean.
- Intrapartum fetal mortality rate remained unaffected by the declining cesarean section rate.
Conclusions:
- A strategic shift in obstetric practice can effectively reduce cesarean section rates.
- Modifications in managing breech presentation and promoting vaginal birth after cesarean are key factors.
- Future reductions in multiple repeat cesarean sections are anticipated.