title: Cesarean birth: how to reduce the rate.
abstract: The cesarean section rate, which approached 25%, has stabilized and started a modest decline. A stated United States national goal by the year 2000 is a rate of 15%. Suggested rates are 12% for primary and 3% for repeat cesarean sections. The major indications for cesarean section are prior cesarean delivery (8%), dystocia (7%), breech presentation (4%), fetal distress (2% to 3%), and others. The major areas of reduction must occur in the categories of prior cesarean delivery and dystocia. An expanded use of trial of labor and vaginal birth after a prior cesarean section will produce further reductions. Countries in Europe achieve > 50% vaginal birth after a prior cesarean section compared with 25% in the United States. A heightened awareness must occur regarding the decision to perform the first cesarean section. The residual impact, a scarred uterus, affects 12% to 14% of women seen for delivery. Even if 50% achieve a vaginal birth after a prior cesarean section, the national goals are unachievable. The obstetrician must consciously consider the impact of "once a cesarean, always a scar."
authors.affiliation: Department of Obstetrics and Gynecology, Women's and Children's Hospital, Los Angeles County-University of Southern California Medical Center, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Paul
authors.forename: D A
authors.initials: DA
authors.lastname: Miller
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006801:Humans; D011247:Pregnancy; D014481:United States