title: Why do multiparous women with a history of vaginal delivery give birth by cesarean section?
abstract: OBJECTIVE
  A cesarean section (C-section) is performed to deliver a baby through the mother's abdomen. In recent years, the rate of incidences requiring a C-section is steadily increasing all over the world. Advanced maternal age, chronic health problems, multiple pregnancies as a result of the development of assisted reproductive technologies, and an insufficient supplementary health network can be considered as the reasons why mothers and obstetricians prefer a C-section. Our study aimed to identify the risk factors for the need of C-section in women with a history of vaginal delivery.
  
  
  METHODS
  238 multiparous women with a history of vaginal birth at 37-42 gestational weeks were enrolled in our study. 110 women had underwent C-section. Control group was chosen randomly from women giving birth by vaginal route.
  
  
  RESULTS
  Overall, 238 multiparous women with a history of vaginal delivery at 37-42 gestational weeks were enrolled in our study. The history of operative delivery, that of labor induction and presence of meconium and the indication of admission to the delivery room were different between groups. A lower Bishop score and biophysical profile, smaller gestational period, and lower birth weight were associated with the group requiring a C-section, whereas older age and a long time interval from the previous birth were associated with the group not requiring a C-section.
  
  
  CONCLUSIONS
  A strategy involving either labor induction or not could be individualized for each patient to eliminate the risk factors for adverse outcomes. To identify criteria for the standardization of labor management, further studies are needed.
authors.affiliation: Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey.
authors.forename: Hale Göksever
authors.initials: HG
authors.lastname: Çelik
authors.affiliation: Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey.
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Bestel
authors.affiliation: Department of Obstetrics and Gynecology, İstanbul University İstanbul School of Medicine Hospital, İstanbul, Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Çelik
authors.affiliation: Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey.
authors.forename: Alev Atış
authors.initials: AA
authors.lastname: Aydın
keywords: Cesarean section; multiparity; vaginal birth