Informing the patient and the community about the implications of primary cesarean.

Education of patients and the community should begin with an acknowledgment of the increase in primary and secondary morbidity and mortality associated with the initial cesarean delivery. Women with cesarean birth have a higher rate of rehospitalization for various indications, including surgical site infections. The direct cost for cesarean-related surgical site infection alone is in the tens of millions of dollars. It is important for patients to appreciate risk factors that lead to an increase the risk for primary cesarean, such as obesity, and medical comorbidities. Education on these factors allows in some instances for preconception interventions that can potentially lower the risk for primary cesarean. The obstetrician and the maternal fetal medicine subspecialist have an obligation to focus on evidence-based obstetrical practices that can lead to a more acceptable primary cesarean rate for the obstetrical population. Patient and community awareness can contribute to the promotion of this expectation in obstetrical practice.