Skip to main content
SpringerLink
Log in

Methods for Safe Reduction of Cesarean Section Rates

  • Chapter
Cesarean Section

Part of the book series: Clinical Perspectives in Obstetrics and Gynecology ((CPOG))

  • 144 Accesses

Abstract

This chapter is presented under the assumption that cesarean section rates in the United States should be reduced. An understanding of the reasons that lead obstetricians to perform cesarean sections should provide the necessary information needed to effect such a change in practice patterns Such a recommendation was already made by a National Consensus Development Conference in 1980, when the national rate was still below 17%.1 Since then, it has further increased at an annual rate of approximately 1% until a plateau of approximately 24% was reached in the early 1990s (Figure 11.1).2,3 Some physicians have nevertheless challenged the effort toward a reduction in cesarean section rates,4,5 and a level of general hesitance within the profession seems to remain.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. National Institutes of Health. Cesarean Childbirth: Report of a Consensus Development Conference. Bethesda, Maryland: Department of Health and Human Services, 1981. (Publication no. DHHS (NIH) 82–2067)

    Google Scholar 

  2. Stafford RS. Alternative strategies for controlling rising cesarean section rates. JAMA 1990; 263: 683–687.

    Article  PubMed  CAS  Google Scholar 

  3. Anonymous. Rates of cesarean delivery—United States 1991. Morbid Mortal Wkly Rep 1993; 42: 285–289. JAMA 1993; 269: 2360.

    Google Scholar 

  4. Abraham L. Cesarean on demand. Am Medical News 1988 Nov 4: 1830.

    Google Scholar 

  5. Feldman GB, Friedman JA. Prophylatic cesarean section at term? N Engl J Med 1985; 312: 1264–1267.

    Article  PubMed  CAS  Google Scholar 

  6. Guidelines for vaginal delivery after a previous cesarean birth, statement of the Committee on Obstetrics: Maternal and Fetal Medicine. Washington, DC: American College of Obstetricians and Gynecologists, 1984.

    Google Scholar 

  7. New guidelines for VBAC. statement of the Committee on Obstetrics: Maternal and Fetal Medicine. Washington, DC: American College of Obstetricians and Gynecologists, 1988.

    Google Scholar 

  8. Hannah WJ, Baskett TF, Chance GW, et al. Indications for cesarean section: final statement of the panel of the National Consensus Development Conference on Aspects of Cesarean Birth. Can Med Assoc J 1986; 134: 1348–1352.

    Google Scholar 

  9. Marieskind HI. An evaluation of cesarean section in the United States. Washington, DC: U.S. Department of Health, Education, and Welfare, Office of the Assistant Secretary for Planning and Evaluation, 1980.

    Google Scholar 

  10. Rostow VP, Osterweis M, Bulger RJ. Medical professional liability and the delivery of obstetrical care. N Engl J Med 1989; 321: 1057–1060.

    Article  PubMed  CAS  Google Scholar 

  11. Carpenter MW, Soule D, Yates WT, Meeker CL. Practice environment in association with obstetric decision making regarding abnormal labor. Obstet Gynecol 1987; 70: 657–662.

    PubMed  CAS  Google Scholar 

  12. Goyert GL, Bottoms SF, Treadwell MC, Nehra PC. The physician factor in cesarean birth rates. N Engl J Med 1989; 320: 706–709.

    Article  PubMed  CAS  Google Scholar 

  13. Newton ER, Higgins CS. Factors associated with hospital-specific cesarean birth rates. J Reprod Med 1989; 34: 407–411.

    PubMed  CAS  Google Scholar 

  14. Localio AR, Lawthers AG, Bengtson JA, et al. Relationship between malpractice claims and cesarean delivery. JAMA 1993; 269: 366–373.

    Article  PubMed  CAS  Google Scholar 

  15. Rutkow IM. Obstetrics and gynecologic operations in the United States, 1979 to 1984. Obstet Gynecol 1986; 67: 755–759.

    Article  PubMed  CAS  Google Scholar 

  16. Rosen MG, Dickinson JC, Westhoff CL. Vaginal birth after cesarean: a meta-analysis of morbidity and mortality. Obstet Gynecol 1991; 77: 465–470.

    PubMed  CAS  Google Scholar 

  17. Porreco R, Meier P. Trial of labor in patients with multiple cesarean sections. J Reprod Med 1983; 28: 770–776.

    PubMed  CAS  Google Scholar 

  18. Novas J, Myers SA, Gleicher N. Obstetric outcome of patients with more than one previous cesarean section. Am J Obstet Gynecol 1989; 160: 364–367.

    PubMed  CAS  Google Scholar 

  19. Asakura H, Myers SA. Multiple cesarean section: A five year experience with 434 patients. Am J Obstet Gynecol 1993; 168: 437 (abstr).

    Google Scholar 

  20. Ophir E, Yagoda A, Rojansky N, Oettinger M. Trial of labor following cesarean section: dilemma. Obstet Gynecol Surv 1988; 44: 19–24.

    Article  Google Scholar 

  21. Gleicher N, Vermesh M, Rotmensch Z, Thornton J, Elrad H. Cesarean section patterns: influence of a perinatology service. Mount Sinai J Med 1985; 52: 100–105.

    CAS  Google Scholar 

  22. Laube DW, ed. Core curriculum for residents of obstetrics and gynecology. Washington, DC: Council on Resident Education, 1992: 103.

    Google Scholar 

  23. Gleicher N. Breast disease programs in obstetrics and gynecology: a plea for training in mammography. Am J Obstet Gynecol 1989; 161: 267–270.

    PubMed  CAS  Google Scholar 

  24. Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer J. Opinion leaders vs. audit and feedback to implement practice guidelines. Delivery after previous cesarean section. JAMA 1991; 265: 2202–2207.

    Article  PubMed  Google Scholar 

  25. Barrett JFR, Jarvis GJ, MacDonald HN, Buchan PC, Tyrrell SN, Lilford RJ. Inconsistencies in clinical decisions in obstetrics. Lancet 1990; 336: 549–551.

    Article  PubMed  CAS  Google Scholar 

  26. Notzen FC, Placek PJ, Taffei SM. Comparison of national cesarean-section rates. N Engl J Med 1987; 316: 386–389.

    Article  Google Scholar 

  27. Stafford RS. The impact of nonclinical factors on repeat cesarean section. JAMA 1991; 265: 59–63.

    Article  PubMed  CAS  Google Scholar 

  28. Gleicher N. In reply. JAMA 1985; 253: 3248–3249.

    Google Scholar 

  29. Gibbs CE. Planned vaginal delivery following cesarean section. Clin Obstet Gynecol 1980; 23: 507–515.

    Article  PubMed  CAS  Google Scholar 

  30. Martin JN Jr, Harris BA Jr, Huddelston JF, et al. Vaginal delivery following previous cesarean birth. Am J Obstet Gynecol 1983; 146: 255–263.

    PubMed  Google Scholar 

  31. Gellman E, Goldstein MS, Kaplan S, Shapiro WJ. Vaginal delivery after cesarean section experience in private practice. JAMA 1983; 249: 2935–2937.

    Article  PubMed  CAS  Google Scholar 

  32. Gleicher N. The cesarean section epidemic. Mt Sinai J Med 1986; 53: 563–565.

    PubMed  CAS  Google Scholar 

  33. Placek PJ, Taffei SM, Molen M. Cesarean rates increases in 1985. Am J Public Health 1987; 77: 241–242.

    Article  PubMed  CAS  Google Scholar 

  34. Porreco RP. High cesarean section rates: a new perspective. Obstet Gynecol 1985; 65: 307–311.

    PubMed  CAS  Google Scholar 

  35. MacDonald D, Grant A, Sheridan-Penetra M, Boylan P, Chalmers I. The Dublin randomized control trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynecol 1985; 152: 524–539.

    PubMed  CAS  Google Scholar 

  36. Confino E, Gleicher N, Elrad H, Ismajovich B, David MP. The breech dilemma: a review. Obstet Gynecol Surv 1985; 156: 6–10.

    Google Scholar 

  37. Myers SA, Gleicher N. Breech delivery: why the dilemma? Am J Obstet Gynecol 1987; 156: 6–10.

    PubMed  CAS  Google Scholar 

  38. Collea JV, Chein C, Quilligan EJ. The randomized management term breech presentation: a study of 208 cases. Am J Obstet Gynecol 1980; 137: 235–244.

    PubMed  CAS  Google Scholar 

  39. Green JE, McLean F, Smith LP, Usher R. Has an increased cesarean section rate for term breech delivery reduced the incidence of birth asphyxia, trauma and death? Am J Obstet Gynecol 1982; 142: 643–648.

    PubMed  CAS  Google Scholar 

  40. Kitchen W, Ford GW, Doyle LW, et al. Cesarean section or vaginal delivery at 24 to 28 weeks gestation: comparison of survival and neonatal and two-year morbidity. Obstet Gynecol 1985; 66: 149–157.

    PubMed  CAS  Google Scholar 

  41. Woods JR. Effect of low birth weight breech delivery on neonatal mortality. Obstet Gynecol 1979; 53: 735–740.

    PubMed  Google Scholar 

  42. Gimovsky ML, Wallace RL, Shifrin BS, et al. Randomized management of the nonfrank breech presentation at term, a preliminary report. Am J Obstet Gynecol 1983; 146: 34–40.

    PubMed  CAS  Google Scholar 

  43. Fishman A, Grubb DK, Kovacs BW. Vaginal delivery of non vertex second twin. Am J Obstet Gynecol 1993;168:861–864.

    PubMed  CAS  Google Scholar 

  44. Myers SA, Gleicher N. A successful program to lower cesarean-section rates. N Engl J Med 1988; 319: 1511–1516.

    Article  PubMed  CAS  Google Scholar 

  45. Quilligan E. Cesarean section: modern perspective. In: Queenan JT, ed. Management of high-risk pregnancy, 2nd Ed. Oradell, NJ: Medical Economics, 1985: 594–600.

    Google Scholar 

  46. Anonymous. Childbirth. Chicago Tribune 1993. Jan (sect 7) 17: 2.

    Google Scholar 

  47. Tay SK, Tsakok FHM, Ng CSA. The use of intradepartmental audit to contain cesarean section rate. Int J Gynecol Obstet 1992; 39: 99–103.

    Article  CAS  Google Scholar 

  48. Socol ML, Garcia PM, Peaceman AM, Dooley SL. Reducing cesarean section births at a primarily private university hospital. Am J Obstet Gynecol 1993; 168: 1748–1758.

    PubMed  CAS  Google Scholar 

  49. Gleicher N. Cesarean section rates in the United States. The short term failure of the National Consensus Development Conference in 1980. JAMA 1984; 252: 3273–3276.

    Article  PubMed  CAS  Google Scholar 

  50. Inglehart JK. Health policy report. N Engl J Med 1987; 316: 960–965.

    Article  Google Scholar 

  51. Myers S, Gleicher N. The Mount Sinai cesarean section reduction program: automated data selection and peer review. Qual Lett 1991; 3: 10–17.

    Google Scholar 

  52. Battaglia FC. Reducing the cesarean section rate safely. N Engl J Med 1988; 319: 1540–1541.

    Article  PubMed  CAS  Google Scholar 

  53. Heynes de Regt R, Minkoff HL, Feldman J, Schwarz RH. Relation of private or clinical care to the cesarean birth rate. N Engl J Med 1986; 315: 6619–6624.

    Google Scholar 

  54. Lopez-Zeno JA, Peaceman AM, Adasher JA, Socol ML. A controlled trial of a program for the active management of labor. N Engl J Med 1992; 326: 450–454.

    Article  PubMed  CAS  Google Scholar 

  55. Sandmire HF. In discussion of reference 48. Am J Obstet Gynecol 1993; 168: 1754–1756.

    Google Scholar 

  56. Raynor BD. The experience with vaginal birth after cesarean delivery in a small rural community practice. Am J Obstet Gynecol 1993; 168: 60–62.

    PubMed  CAS  Google Scholar 

  57. Iglesias S, Burn R, Saunders LD. Reducing the cesarean rate in a rural community hospital. Can Med Assoc J 1991; 145: 1456–1459.

    Google Scholar 

  58. Peck T. Low cesarean rates possible. Ob Gyn News 1992; 27: 9.

    Google Scholar 

  59. Butler J, Abrams B, Parker J, Roberts JM, Laros RK Jr. Supportive nurse-midwife care is associated with a reduced incidence of cesarean section. Am J Obstet Gynecol 1993; 168: 1407–1413.

    PubMed  CAS  Google Scholar 

  60. Piturro M. Managed care obstetrical services: an option where everyone wins. Group Practice Managed Health Care News 1992 Feb: 16.

    Google Scholar 

  61. Dillon WP, Choate JW, Nusbaum ML, Amao-McCarthy M, McCall M, Rosen MG. Obstetric care and cesarean birth rates: a program to monitor quality of care. Obstet Gynecol 1992; 80: 731–737.

    PubMed  CAS  Google Scholar 

  62. Ophir E, Oettinger M, Yagoda A, Makovits Y, Rojansky N, Shapiro H. Breech presentation after cesarean section. Always a section? Am J Obstet Gynecol 1989; 161: 25–28.

    PubMed  CAS  Google Scholar 

  63. Strong TH Jr, Phelan JP, Ahn MO, Sarno AP Jr. Vaginal birth after cesarean delivery in the twin gestation. Am J Obstet Gynecol 1989; 161: 29–32.

    PubMed  Google Scholar 

  64. Flamm BL, Goings JR. Vaginal birth after cesarean section: is supected fetal macro-somia a contraindication? Obstet Gynecol 1989;74:694-698.

    PubMed  CAS  Google Scholar 

  65. Beall M, Eglinton GS, Clark SL, Phelan JP. Vaginal delivery after cesarean section: the unknown uterine scar. J Reprod Med 1984; 29: 31–36.

    PubMed  CAS  Google Scholar 

  66. Davison L, Easterling TR, Jackson JC, Benedetti TJ. Breech extraction of low-birth-weight second twins: can cesarean section be justified? Am J Obstet Gynecol 1992; 166: 497–502.

    PubMed  CAS  Google Scholar 

  67. Taffel SM. Cesarean section in America: dramatic trends, 1970–1987. Stat Bull Metrop Life Insur Co 1989; 70: 2–11.

    CAS  Google Scholar 

  68. Williams RL, Chen PM. Identifying the sources of the recent decline in perinatal mortality rates in California. N Engl J Med 1982;306:207–214.

    Article  PubMed  CAS  Google Scholar 

  69. Malloy MH, Onstad L, Wright E, et al. The effect of cesarean delivery on birth outcome in very low birth weight infants. Obstet Gynecol 1991; 77: 498–499.

    PubMed  CAS  Google Scholar 

  70. Anderson GD, Bada HS, Shaver DC, et al. The effect of cesarean section on intraven-tricular hemorrhage in the preterm infant. Am J Obstet Gynecol 1992; 166: 1091–1101.

    PubMed  CAS  Google Scholar 

  71. Haverkamp AD, Orleans M, Langendoerfer S, et al. A controlled trial of the differential effects of intrapartum fetal monitoring. Am J Obstet Gynecol 1979; 134: 399–404.

    PubMed  CAS  Google Scholar 

  72. Clark SL, Gimovsky ML, Miller FC. The scalp stimulation test: a clinical alternative to fetal scalp blood sampling. Am J Obstet Gynecol 1983; 148: 274–277.

    Google Scholar 

  73. Gordon D, Milberg J, Daling J, Hickok D. Advanced maternal age and risk factor for cesarean delivery. Obstet Gynecol 1991; 77: 493–497.

    PubMed  CAS  Google Scholar 

  74. Wagner MG, St Clair PA. Are in-vitro fertilization and embryo transfer of benefit to all? Lancet 1989; 2: 1027–1030.

    Article  PubMed  CAS  Google Scholar 

  75. Sauer MU, Paulson RJ, Lobo RA. Reversing the natural decline in human fertility! An extended clinical trial of oocyte donation to women of advanced reproductive age. JAMA 1992; 268: 1275–1279.

    Article  PubMed  CAS  Google Scholar 

  76. Gibbs RS, Amstey MS, Sweek RL, Mead PB, Sever JL. Management of genital herpes infection in pregnancy. Obstet Gynecol 1988; 71: 779–780.

    PubMed  CAS  Google Scholar 

  77. Randolph AG, Washington E, Prober CG. Cesarean delivery for women presenting with genital herpes lesions. JAMA 1993; 270: 77–82.

    Article  PubMed  CAS  Google Scholar 

  78. Chuang T. Neonatal herpes: incidence, prevention and consequences. Am J Prev Med 1988; 4: 47–53.

    PubMed  CAS  Google Scholar 

  79. Gibbs RS, Amstey MS, Lezotte DC. Role of cesarean delivery in preventing neonatal herpes infection. JAMA 1993; 170: 94–95.

    Article  Google Scholar 

  80. Luthy DA, Wardinsky T, Shurtleff DB, et al. Cesarean section before the onset of labor and subsequent motor function in infants with meningomyelocele diagnosed ante-natally. N Engl J Med 1991; 324: 662–666.

    Article  PubMed  CAS  Google Scholar 

  81. Garite TJ, Linzey EM, Freeman RK, et al. Fetal heart rate patterns and fetal distress in fetuses with congenital anomalies. Obstet Gynecol 1979; 53: 716–721.

    PubMed  CAS  Google Scholar 

  82. Phillips RN, Thornton J, Gleicher N. Physician bias in cesarean sections. JAMA 1982; 248: 1082–1084.

    Article  PubMed  CAS  Google Scholar 

  83. Berkowitz GS, Fiarman GS, Mojica MA, Bauman J, Haynes de Regt R. Effect of physician characteristics on the cesarean birth rate. Am J Obstet Gynecol 1989; 161: 146–149.

    PubMed  CAS  Google Scholar 

  84. Bashore RA, Phillips WH Jr, Brinkman CR III. A comparison of morbidity of midforceps and cesarean delivery. Am J Obstet Gynecol 1990; 162: 1428–1432.

    PubMed  CAS  Google Scholar 

  85. Gould JB, Davey B, Stafford RS. Socioeco-nomic differences in rates of cesarean section N Engl J Med 1989; 321: 233–239.

    Article  PubMed  CAS  Google Scholar 

  86. Haas JS, Udvarhelyi S, Epstein AM. The effect of health coverage for uninsured pregnant women on maternal health and the use of cesarean section. JAMA 1993; 270: 61–64.

    Article  PubMed  CAS  Google Scholar 

  87. Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a U.S. hospital, a randomized controlled trial. JAMA 1991; 265: 2197–2201.

    Article  PubMed  CAS  Google Scholar 

  88. Rosen NG. Doula at the bedside of the patient in labor. JAMA 1991; 265: 2236–2237.

    Article  PubMed  CAS  Google Scholar 

  89. Public Health Service. Healthy people 2000: National health promotion and disease prevention objectives—full report with com mentary. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, 1991. (DHHS publication no. (PHS) 91–60212)

    Google Scholar 

  90. Spellacy WN. Vaginal birth after cesarean: a reward/penalty system for national implementation. Obstet Gynecol 1991; 78: 316–317.

    PubMed  CAS  Google Scholar 

Download references

Authors
  1. Norbert Gleicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard H. Demir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeanne B. Novas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen A. Myers
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Kaiser Permanente, Southern California Permanente Medical Group, 92505, Riverside, CA, USA

    Bruce L. Flamm M.D. (Research Chairman) (Research Chairman)

  2. Department of Obstetrics and Gynecology, University of California-Irvine Medical Center, 92668, Orange, CA, USA

    Edward J. Quilligan M.D. (Professor Emeritus) (Professor Emeritus)

Rights and permissions

Reprints and permissions

Copyright information

© 1995 Springer-Verlag New York, Inc.

About this chapter

Cite this chapter

Gleicher, N., Demir, R.H., Novas, J.B., Myers, S.A. (1995). Methods for Safe Reduction of Cesarean Section Rates. In: Flamm, B.L., Quilligan, E.J. (eds) Cesarean Section. Clinical Perspectives in Obstetrics and Gynecology. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2482-2_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-2482-2_11

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7556-5

  • Online ISBN: 978-1-4612-2482-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation