The rise in caesarean section rate: the same indications but a lower threshold.

OBJECTIVE: To investigate the reasons for the rise in caesarean section rate and note any change in indications.
DESIGN: A retrospective, descriptive study comparing the years 1962 and 1992.
SETTING: A large city centre teaching hospital.
RESULTS: There was an overall increase in the caesarean section rate from 6-8% in 1962 to 18.1% in 1992. No single cause contributed more than 30% towards this increase. The main indications in both years were similar: failure to progress (42.2% vs 36.7%) and fetal indications (18.1% vs 18.9%). The largest relative increases were in the malpresentation group (10.8% vs 16%) and previous caesarean section (4.5% vs 15.2%).
CONCLUSIONS: These results suggest that there has been a lowering in the overall threshold concerning the decision to carry out a caesarean section rather than changes in obstetric management. Obstetricians and the women in their care have to decide whether the current balance between risk and benefit is acceptable or whether they wish to alter the underlying philosophy if any significant reduction is to be sustained.