Limiting the caesarean section rate in low risk pregnancies is key to lowering the trend of increased abdominal deliveries: an observational study

Abstract

BackgroundAs the rate of Caesarean sections (CS) continues to rise in Western countries, it is important to analyze the reasons for this trend and to unravel the underlying motives to perform CS. This research aims to assess the incidence and trend of CS in a population-based birth register in order to identify patient groups with an increasing risk for CS.MethodsData from the Flemish birth register 'Study Centre for Perinatal Epidemiology' (SPE) were used for this historic control comparison. Caesarean sections (CS) from the year 2000 (N = 10540) were compared with those from the year 2008 (N = 14016). By means of the Robson classification, births by Caesarean section were ordered in 10 groups according to mother - and delivery characteristics.ResultsOver a period of eight years, the CS rise is most prominent in women with previous sections and in nulliparous women with a term cephalic in spontaneous labor. The proportion of inductions of labor decreases in favor of elective CS, while the ongoing inductions of labor more often end in non-elective CS.ConclusionsIn order to turn back the current CS trend, we should focus on low-risk primiparae. Avoiding unnecessary abdominal deliveries in this group will also have a long-term effect, in that the number of repeat CS will be reduced in the future. For the purpose of self-evaluation, peer discussion on the necessity of CS, as well as accurate registration of the main indication for CS are recommended.

Is place of birth associated with mode of birth? The effect of hospital on caesarean section rates in a public metropolitan health service

“…The practice style of the hospital; whether it was a teaching hospital and the availability of technology have been suggested as possible influences (amongst others) on decision-making and could be a plausible explanation for the variation in the hospitals under review in our study. Similarly to Delbaere et al 22 , they encourage medical audits and feedback to obstetricians as useful strategies in addressing rising caesarean section rates.…”

Caesarean section rates in subgroups of women and perinatal outcomes

“…[16][17][18][19][20] For instance, among parous women with previous CS, the CS rate in the Netherlands was 47.1%. CS rate in women with a multiple gestation is still <50% whereas the CS rate in preterm birth is among the lowest.…”

“…CS rate in women with a multiple gestation is still <50% whereas the CS rate in preterm birth is among the lowest. [16][17][18][19][20] All these factors contribute to an overall relatively low CS rate.…”

Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study

“…3 Although the absolute incidence of caesarean section is higher in other western countries compared with the Netherlands, a similar rise in caesarean sections occurred in other western countries. [4][5][6][7] The progression of the birth process and concomitant interventions are associated with maternal characteristics such as age, parity, body mass index (BMI), ethnicity, illness and infant birth weight, as well as with organisational factors such as existing guidelines, the availability of 24 hours pain relief, the profession of the obstetric care provider (midwife vs physician) and the level of care (primary/secondary). [8][9][10][11][12] Moreover, maternal anxiety might play a role in the birth process.…”