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Cesarean birth: how to reduce the rate
1Department of Obstetrics and Gynecology, Women's and Children's Hospital, Los Angeles County-University of Southern California Medical Center, USA.
American Journal of Obstetrics and Gynecology
|June 1, 1995
Summary
The cesarean section rate is declining but remains high. Reducing primary cesarean deliveries and increasing vaginal birth after cesarean are crucial for meeting national goals.
Area of Science:
- Obstetrics and Gynecology
- Public Health
Background:
- The cesarean section rate in the United States has stabilized around 25%, exceeding national goals.
- Major indications include prior cesarean delivery, dystocia, breech presentation, and fetal distress.
Purpose of the Study:
- To analyze cesarean section rates and identify key areas for reduction.
- To evaluate the potential impact of vaginal birth after cesarean section on overall rates.
Main Methods:
- Analysis of cesarean section rates and indications.
- Comparison of vaginal birth after cesarean rates with European countries.
Main Results:
- Cesarean rates have stabilized but require further reduction to meet the 15% national goal.
- Prior cesarean delivery and dystocia are primary targets for reduction.
- Expanded trial of labor and vaginal birth after cesarean could significantly lower rates, but current US rates (25%) lag behind Europe (>50%).
Conclusions:
- Achieving national cesarean section goals is challenging due to the high rate of prior cesarean deliveries.
- Conscious consideration of the first cesarean delivery decision is vital to minimize uterine scarring and facilitate future vaginal births.