The cesarean birth epidemic: Trends, causes, and solutions

Porreco, Richard P.; Thorp, James A.

doi:10.1016/s0002-9378(96)70148-5

Cited by 107 publications

(71 citation statements)

References 27 publications

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“…1 The causal factors are complex and incompletely understood. 2,3 Concerns have been expressed about potential adverse effects, especially in relation to short-term morbidity in the mother and child. 4,5 Studies on the effects of previous caesarean section on future pregnancies have focused mainly on the maternal and fetal risks of scar rupture associated with vaginal birth.…”

Section: Introductionmentioning

confidence: 99%

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

2003

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Glasgow ePrints Servicehttp://eprints.gla.ac.uk SummaryBackground Caesarean section is associated with an increased risk of disorders of placentation in subsequent pregnancies, but effects on the rate of antepartum stillbirth are unknown. We aimed to establish whether previous caesarean delivery is associated with an increased risk of antepartum stillbirth.Methods We linked pregnancy discharge data from the Scottish Morbidity Record (1980-98) and the Scottish Stillbirth and Infant Death Enquiry . We estimated the relative risk of antepartum stillbirth in second pregnancies using timeto-event analyses.Findings For 120 633 singleton second births, there were 68 antepartum stillbirths in 17 754 women previously delivered by caesarean section (2·39 per 10 000 women per week) and 244 in 102 879 women previously delivered vaginally (1·44; p<0·001). Risk of unexplained stillbirth associated with previous caesarean delivery differed significantly with gestational age (p=0·04); the excess risk was apparent from 34 weeks (hazard ratio 2·23 [95% CI 1·48-3·36]). Risk was not attenuated by adjustment for maternal characteristics or outcome of the first pregnancy (2·74 [1·74-4·30]). The absolute risk of unexplained stillbirth at or after 39 weeks' gestation was 1·1 per 1000 women who had had a previous caesarean section and 0·5 per 1000 in those who had not. The difference was due mostly to an excess of unexplained stillbirths among women previously delivered by caesarean section.Interpretation Delivery by caesarean section in the first pregnancy could increase the risk of unexplained stillbirth in the second. In women with one previous caesarean delivery, the risk of unexplained antepartum stillbirth at or after 39 weeks' gestation is about double the risk of stillbirth or neonatal death from intrapartum uterine rupture.

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Section: Introductionmentioning

confidence: 99%

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

2003

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“…Studies suggest several factors related to the high cesarean rate, including obstetrician's convenience with this programmed intervention 9 , physicians' lack of training for unexpected situations during delivery 10 , lack of integration between prenatal and childbirth services, and the hospital shift system, which does not allow women to remain in labor from one shift to the next 11 .…”

Section: Introductionmentioning

confidence: 99%

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

et al. 2006

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Brazil has one of the world's highest cesarean section rates. Contributing factors include the organization of obstetric practice, physicians' attitudes, and women's preferences and decisions. This study aimed to identify factors associated with cesarean sections in a public maternity hospital in Rio de Janeiro. A case-control study was conducted with 231 cesarean sections (cases) and 230 vaginal deliveries (controls). Hierarchical logistic regression analysis was performed, based on a conceptual model. Factors associated with increased odds of cesarean section were: primiparity; mother's age 20-34; last birth by cesarean; cervical dilatation < 3cm at admission; patient request; daytime birth; male attending obstetrician; obstetrician on duty for more than 24 hours a week; obstetrician with private practice; gestational hypertension; non-cephalic presentation; and gestational age > 41 weeks. Factors associated with lower odds of cesarean were: gestational age < 37 weeks; leaving home with signs of labor, use of oxytocin; and amniotomy. In this hospital, interventions aimed to modify the above-mentioned factors can help lower the cesarean rate.

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“…C-section rates) since these are often more influenced by supply or induced demand rather than by need. This results in the well-documented large variations in operative delivery rates throughout the world (Thiery & Derom 1986;Lomas & Enkin 1989;Barros et al 1991;Macfarlane & Chamberlain 1993;Francome & Savage 1993;Notzon et al 1994;van Roosmalen & Van der Does 1995;Porreco & Thorp 1996). It is possible, however, to consider only those interventions that are performed for absolute maternal indications (AMI) such as severe ante-partum haemorrhage, placenta praevia and abruptio placentae; severe postpartum haemorrhage requiring surgical intervention; foetopelvic disproportion, including prerupture and uterine rupture; shoulder or transverse lie and brow presentation.…”

Section: Introductionmentioning

confidence: 99%

Monitoring unmet obstetric need at district level in Morocco

Belghiti¹,

Brouwere

Kegels

et al. 1998

Tropical Med Int Health

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SummaryUnmet obstetric need was assessed in Taounate province (Morocco) during the year 1995 by monitoring rates of major obstetric intervention for absolute maternal indications. We report results in terms of spatial distribution of the failures of the health care system to provide women with essential emergency obstetric care. An estimated 135 women with life-threatening conditions did not benefit from the obstetric interventions they required. The paper documents the effects of the monitoring process on the way the provincial team changed their way of dealing with deliveries. Assessment of unmet obstetric need in Taounate province proved feasible and affordable without external budgetary inputs. It provided the team with information on the magnitude of a previously ignored problem. The results were so dramatic as to lead the team to look for causes and solutions. These were clearly not merely technical but systemic in nature.keywords Morocco, obstetrics, needs assessment, monitoring, district health system, unmet obstetric need.correspondence Vincent

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The cesarean birth epidemic: Trends, causes, and solutions

Cited by 107 publications

References 27 publications

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

Monitoring unmet obstetric need at district level in Morocco

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