Troubling Increase In Repeat Cesarean Delivery, Inadequate Explanations

National statistics reported a 63 percent decline in the rate of vaginal birth after cesarean delivery between 1996 and 2003, with subsequent rising rates of repeat cesarean delivery. In this study, researchers set out to examine the patterns of documented indications for the change in trend.

In examining the medical records of over 4500 women who had live births, data revealed that of the 493 women who underwent repeat cesarean delivery without having gone into labor, "elective" (36%) and "maternal request" (18%) were the most common reasons recorded. However, nearly 10 percent of the women had no reasons documented at all for their repeat cesarean delivery. More clinically explicit indications for having a repeat cesarean delivery usually include reasons such as a woman having a history of two or more prior cesarean deliveries or breech birth.

"Strategies to improve physician-recorded indications for repeat cesarean delivery in medical records are essential during childbirth hospitalization if the mechanisms contributing to the ever-increasing cesarean delivery rate are to be identified and more fully understood," states lead researcher, Dr. Mona Lydon-Rochelle, from the University of Washington, Seattle. "However scientifically and objectively researchers study the decision-making process among women with a prior cesarean delivery, they still need to recognize that oversimplification as to the need for surgery makes the accuracy of reasons given for such decisions suspect."

Lydon-Rochelle adds that future research should examine how clinicians and women anticipate, discuss, and make decisions about childbirth after a prior cesarean delivery within the context of actual prenatal care, because this information would provide useful insights about the real demands and challenges confronting women and their obstetricians, family practice physicians, and nurse-midwives.

This study is published in Birth, vol. 33, no. 1, 2006.

Dr. Mona T. Lydon-Rochelle is Associate Professor in the University of Washington's School of Nursing and Public Health and Community Medicine.