The rising cesarean section rate: can it safely be reversed?

Reports from the United States and around the world have marked a steadily rising cesarean section rate. Although the indications that account for the increase are generally agreed upon (previous cesarean section, dystocia, fetal distress, and malpresentation), the benefits derived from the liberalized use of cesarean section to deal with these diagnoses have not been carefully documented. In an attempt to determine if the cesarean section rate could be lowered with no adverse effect on neonatal outcome, 105,848 deliveries at Downstate-Kings County Hospital from 1961 through 1977 were reviewed. The 9727 cesarean sections performed were evaluated to determine the reasons for the increasing rates and the effect on perinatal outcome. It was concluded that by the use of fetal scalp blood sampling in cases of fetal distress, the use of internal pressure transducers in patients who fail to progress in labor, and allowing selected patients with previous sections to labor, the cesarean section rate might be substantially lowered. The maternal morbidity and mortality were also analyzed.