title: Changed indications for cesarean sections.
abstract: OBJECTIVE
  The aim of this study was to investigate the indications for cesarean sections in the early 1990s as compared to the middle 2000s.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Data were collected from original obstetrical records in a tertiary hospital in 1992 and 2005.
  
  
  RESULTS
  The total cesarean delivery rate rose from 11% to 20%. The main indications for an elective cesarean in 1992 were a pathological fetal lie or a uterine factor. The dominant indication for an elective cesarean in 2005 was a psychosocial indication defined as maternal fear of childbirth or maternal request without any co-existing medical indication. Presumed fetal compromise and prolonged labor remained the main indications for urgent and emergency cesareans. No apparent alterations in population characteristics could be identified for these years.
  
  
  CONCLUSIONS
  The increased rate of elective cesareans for psychosocial indications would reflect altered attitudes towards mode of delivery in the childbearing population and among obstetricians. We suggest that extended support from community antenatal care should be provided and that standardized keys aiding a physician in decision-making procedures concerning the cesarean section practice should be developed.
authors.affiliation: Department of Woman and Child Health, Karolinska University Hospital, Stockholm, Sweden. ylva.vladic-stjernholm@karolinska.se
authors.forename: Ylva Vladic
authors.initials: YV
authors.lastname: Stjernholm
authors.forename: Karin
authors.initials: K
authors.lastname: Petersson
authors.forename: Eva
authors.initials: E
authors.lastname: Eneroth
mesh_terms: D000328:Adult; D001290:Attitude; D002585:Cesarean Section / Q000523:psychology / Q000706:statistics & numerical data / Q000639:trends*; D003657:Decision Making; D017558:Elective Surgical Procedures / Q000639:trends; D005260:Female; D006801:Humans; D010820:Physicians / Q000523:psychology; D011247:Pregnancy; D012189:Retrospective Studies