Troubling increase in repeat cesarean delivery, inadequate explanations

SEATTLE March 8, 2006 A survey conducted to determine the basis for the increased number of repeat cesarean births in the United States found that nearly 10 percent of women had undocumented reasons for the surgery. This study is published in the March issue of Birth: Issues in Perinatal Care.

National statistics reported a 63 percent decline in the rate of vaginal birth after cesarean delivery between 1996 and 2003, with subsequent rising rates of repeat cesarean delivery. In this study, researchers set out to examine the patterns of documented indications for the change in trend.

In examining the medical records of over 4500 women who had live births, data revealed that of the 493 women who underwent repeat cesarean delivery without having gone into labor, "elective" (36%) and "maternal request" (18%) were the most common reasons recorded. However, nearly 10 percent of the women had no reasons documented at all for their repeat cesarean delivery. More clinically explicit indications for having a repeat cesarean delivery usually include reasons such as a woman having a history of two or more prior cesarean deliveries or breech birth.

"Strategies to improve physician-recorded indications for repeat cesarean delivery in medical records are essential during childbirth hospitalization if the mechanisms contributing to the ever-increasing cesarean delivery rate are to be identified and more fully understood," states lead researcher, Dr. Mona Lydon-Rochelle, from the University of Washington, Seattle. "However scientifically and objectively researchers study the decision-making process among women with a prior cesarean delivery, they still need to recognize that oversimplification as to the need for surgery makes the accuracy of reasons given for such decisions suspect."

Lydon-Rochelle adds that future research should examine how clinicians and women anticipate, discuss, and make decisions about childbirth after a prior cesarean delivery within the context of actual prenatal care, because this information would provide useful insights about the real demands and challenges confronting women and their obstetricians, family practice physicians, and nurse-midwives.

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This study is published in BIRTH, vol. 33, no. 1, 2006. Media who would like to receive a PDF of the article should contact professionalnews@bos.blackwellpublishing.net.

Dr. Mona T. Lydon-Rochelle is Associate Professor in the University of Washington's School of Nursing and Public Health and Community Medicine. Her primary research interests are in reproductive and perinatal epidemiology and her research involves identifying childbirth-related adverse maternal health outcomes. She can be reached for questions and interviews at (206) 780-2134.

About the Journal
Birth: Issues in Perinatal Care is a multidisciplinary, refereed journal devoted to issues and practices in the care of childbearing women, infants, and families. It is written by and for professionals in maternal and neonatal health, nurses, midwives, physicians, public health workers, doulas, psychologists, social scientists, childbirth educators, lactation counselors, epidemiologists, and other health caregivers and policymakers in perinatal care.

Blackwell Publishing is the world's leading society publisher, partnering with more than 665 academic, medical, and professional societies. Blackwell publishes over 800 journals and, to date, has published close to 6,000 text and reference books, across a wide range of academic, medical, and professional subjects.


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