title: Managing the primary cesarean delivery rate.
abstract: One third of deliveries in the United States are by cesarean, a rate that far exceeds that recommended by professional organizations and experts. A dominant reason for the high overall cesarean rate is the rising primary cesarean rate. The high primary cesarean rate results from multiple factors, both clinical and nonclinical. This review outlines proposed interventions to lower the primary cesarean rate. We focus on those implementable at a facility level and would likely yield immediate results, including aligning provider incentives for vaginal birth, limiting elective induction of labor, and improving labor management of dystocia and abnormal fetal heart rate tracings.
authors.affiliation: Intermountain Healthcare and the University of Utah Health Sciences Center, Salt Lake City, UT, USA. ware.branch@hsc.utah.edu
authors.forename: David Ware
authors.initials: DW
authors.lastname: Branch
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
mesh_terms: D001946:Breech Presentation / Q000628:therapy; D002585:Cesarean Section / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data* / Q000639:trends*; D036861:Delivery, Obstetric / Q000191:economics / Q000193:education; D004420:Dystocia / Q000601:surgery* / Q000628:therapy; D005249:Fees and Charges; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008880:Midwifery; D010353:Patient Education as Topic; D010820:Physicians / Q000191:economics; D011247:Pregnancy; D014481:United States