This study explores the records documented by physicians based on the indications of cesarean delivery, in order to understand the increasing prevalence of Cesarean deliveries. A detailed documentation of all the births in seven years in the U.S., from 2003 to 2009, was examined to analyze the trends. The rate of Cesarean deliveries increased over these years from 26 to 36.5 percent. “Indications” (such as dilation, fetal orientation, blood pressure, heartbeats, etc.) in each case were studied, and some were found to increase in frequency, while others remained constant. Contribution of each of these factors to the rate of increase in Cesarean deliveries was determined.
In the United States, the rate of cesarean deliveries increased for all the states, and people of all ethnicities and ages, between the years 1996 to 2007. Some of the reasons responsible for such a trend are: a reduction in vaginal births after having had a cesarean delivery, mothers requesting cesarean more often, and maternal health complications leading to the need for a cesarean section. A direct correlation between an increased health risk in expectant mothers and the rate of cesarean deliveries has not been deduced. Hence, the researchers of this study attempted to evaluate the indications of conditions that were present during pregnancy or delivery, which may have led to the need for a cesarean section. The doctors’ documentations from an urban hospital were used for analysis during this study.
* Records documented by physicians for all births, from 2003 to 2009, at a hospital were analyzed.
* The frequencies of first-time Cesareans, repeat Cesareans and vaginal births after a previous cesarean (VBAC) were recorded for each year.
* For each case of delivery, the physicians recorded indications, such as arrested dilation during labor, abnormal fetal heartbeat, multiple fetuses or a fetus that was too large, etc. Failed procedures using the forceps or vacuum, mother’s requests and blood test results were also noted.
* Rate of Cesareans for each indication per 1000 births was calculated.
* The rates of Cesareans between patients in a university setting, patients with high health risks and patients in private hospitals were then compared.
* In seven years, 32,443 babies were born, of whom 10,757 (33.3 percent) were Cesarean. Overall, the rate of first-time Cesareans, as well as repeats, increased from 26.0 percent in 2003 to 36.5 percent in 2009. The rate of vaginal births after a previous Cesarean decreased markedly from 17.8 to 7.8 percent.
* Patients managed by private services as well as high-risk patients had higher Cesarean rates than university patients did.
* Cesareans due to problematic fetal heartbeat, arrested dilation, multiple fetuses, high blood pressure, abnormally large fetuses, and more increased in this period.
* Labor arrest disorders and non-reassuring fetal heart rate tracings were the main reasons for an increase in the rate of cesarean deliveries. Multiple gestations, maternal requests, arrest of dilation and pre-eclampsia (maternal hypertension) were also the main causes.
* Indications like wrong orientation of the fetus, cord and placental placement, arrested descent, etc., showed no increase in this period.
The data used in this study represents only one institution in Connecticut. Thus, according to the authors of this study, the data cannot be generalized to “populations with different demographic and regional characteristics.” Furthermore, as the study is based on data from a single institution, the number of births studied is significantly small and a larger sample size would have been more favorable.
In the United States, rates of first-time and repeat Cesareans are on the rise. The analysis shows that indications that can be determined objectively (such as the orientation of the baby, umbilical cord and placental positions etc.) have remained consistent in their frequencies over these seven years and have not contributed to the increase in frequency of cesarean deliveries. The subjective indications (like fetal heartbeat, labor arrest, size of the fetus, etc.) have increased in frequency, affecting the cesarean frequency proportionately. The decision of mothers and some physicians in opting for repeat Cesareans could be because of health reports suggesting dangers of attempting a VBAC. Patients have an increased influence on the decision-making process in this aspect.
For More Information:
Indications Contributing to the Increasing Cesarean Delivery Rate
Publication Journal: Obstetrics and Gynecology, July 2011
By Emma L. Barber, MD; Lisbet S. Lundsberg, PhD; Yale School of Medicine and Yale School of Public Health, New Haven, Connecticut
*FYI Living Lab Reports Are Summaries of the Original Research.