Cesarean section delivery in the 1980s: international comparison by indication

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Services Research

Background:

• National cesarean section rates vary significantly, influenced by diverse obstetric practices.
• Understanding these differences is crucial for developing strategies to optimize delivery interventions.

Purpose of the Study:

• To compare trends and current levels of cesarean section delivery by indication across four developed nations.
• To identify factors contributing to national disparities in cesarean rates and inform efforts to reduce them.

Main Methods:

• A comparative analysis of cesarean delivery trends by indication was conducted in Norway, Scotland, Sweden, and the United States.
• Data were collected for time intervals centered around 1980, 1985, and 1990, using a standardized set of selection rules for indications.

Main Results:

• The growth rate of cesarean section rates slowed considerably between 1980-1985 and 1985-1990 in all four countries; Sweden experienced an actual decline.
• Fetal distress and prior cesarean section were key drivers of cesarean growth in 1980-1985, but their impact diminished by 1985-1990.
• By 1990, the U.S. had the highest rate (24%) and Sweden the lowest (11%). Previous cesarean delivery and dystocia were primary contributors to the high U.S. rate.

Conclusions:

• Cesarean section rates are nearing stability in the studied countries, with a notable decrease in Sweden.
• Previous cesarean delivery and dystocia represent significant opportunities for reducing cesarean rates in the United States.
• The Swedish experience demonstrates the feasibility of reducing an already low national cesarean section rate.