The cesarean delivery rate can be safely reduced in a developing country.

In an attempt to reduce the cesarean rate without adverse effect on outcome, new guidelines for the management of dystocia, previous cesarean delivery, fetal distress, and breech presentation were introduced in September 1984 in a provincial hospital in Zimbabwe, Africa. Comparison of the 2-year periods before and after September 1984 showed that the cesarean rate had dropped from 16.8 to 8.0%, the maternal mortality rate from 202 to 57 per 100,000 births, and the perinatal mortality rate from 71.9 to 56.2 per 1000 births. During the latter period, use of oxytocin increased from 3.4 to 17.4%. These findings suggest that the adoption of strict guidelines can lead to a decrease in the cesarean rate and an improvement in obstetric outcome.