Cesarean Birth in the United States: Epidemiology, Trends, and Outcomes

Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 7318, Hyattsville, MD 20782, USA.
Clinics in Perinatology (Impact Factor: 2.13). 07/2008; 35(2):293-307, v. DOI: 10.1016/j.clp.2008.03.007
Source: PubMed

ABSTRACT The percentage of United States cesarean births increased from 20.7% in 1996 to 31.1% in 2006. Cesarean rates increased for women of all ages, race/ethnic groups, and gestational ages and in all states. Both primary and repeat cesareans have increased. Increases in primary cesareans in cases of "no indicated risk" have been more rapid than in the overall population and seem the result of changes in obstetric practice rather than changes in the medical risk profile or increases in "maternal request." Several studies note an increased risk for neonatal and maternal mortality for medically elective cesareans compared with vaginal births.

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    • "The flaws in this approach are evident, for example, in the growing controversy over the unintended consequences of routine screening for breast cancer for women (Autier et al., 2011; Roukema, 2013), and in the increasing concern about the longer term (and even epigenetic) potential for adverse effects associated with the continuing rise in the use of caesarean section for an ever wider list of indications in maternity care (MacDorman et al., 2008; Dahlen et al., 2013; Witt et al., 2014). Both seem logical, as a means of preventing adverse events. "
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    ABSTRACT: The linear focus of 'normal science' is unable toadequately take account of the complex interactions that direct health care systems. There is a turn towards complexity theory as a more appropriate framework for understanding system behaviour. However, a comprehensive taxonomy for complexity theory in the context of health care is lacking. This paper aims to build a taxonomy based on the key complexity theory components that have been used in publications on complexity theory and health care, and to explore their explanatory power for health care system behaviour, specifically for maternity care. A search strategy was devised in PubMed and 31 papers were identified as relevant for the taxonomy. The final taxonomy for complexity theory included and defined 11components. The use of waterbirth and the impact of the Term Breech trial showed that each of the components of our taxonomy has utility in helping to understand how these techniques became widely adopted. It is not just the components themselves that characterise a complex system but also the dynamics between them. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Midwifery 06/2015; DOI:10.1016/j.midw.2015.05.009 · 1.71 Impact Factor
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    • "Cesarean deliveries account for a large percentage of all births worldwide [1]; for example, in the USA, cesarean delivery accounts for 30% of all births and the operation represents the most common major surgical procedure for women [2]. In Egypt, the cesarean delivery rate is 22%, with higher rates seen in private hospitals [3]. "
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    ABSTRACT: Abstract OBJECTIVE: To compare extra-abdominal repair of the uterine incision at cesarean delivery with in situ repair. METHODS: The present study was a double-blind randomized controlled trial conducted at a university hospital in Egypt during 2012-2013, and included women with an indication for cesarean delivery. Extra-abdominal repair was used in group 1 (n=500) and in situ repair in group 2 (n=500). The primary outcome measure was the surgery duration. RESULTS: Surgery duration was significantly longer in group 1 than group 2 (49.9±2.3minutes vs 39.9±1.8minutes; P<0.001). More patients in group 1 than in group 2 had postoperative moderate-to-severe pain (165 [33.0%] vs 115 [23.0%]; P=0.001) and needed additional postoperative analgesia (100 [20.0%] vs 50 [10.0%]; P<0.001). Moreover, mean time to bowel movement was longer in group 1 than in group 2 (17.0±2.7hours vs 14.0±1.9hours; P<0.001). CONCLUSION: In situ uterine closure is more advantageous than extra-abdominal repair in terms of surgery duration, postoperative pain and need for additional analgesia, and return of bowel movement. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. KEYWORDS: Cesarean delivery; Exteriorization; In situ repair; Uterine repair site
    International Journal of Gynecology & Obstetrics 11/2014; 127(2):163-6. DOI:10.1016/j.ijgo.2014.05.004 · 1.56 Impact Factor
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    • "Cesarean delivery is a useful and even necessary surgery for many obstetric complications diagnosed before or during labor. The frequency of cesarean delivery has increased worldwide since the 1970s, which has prompted investigation of the factors involved in the genesis of its indications [1]. The percentage of deliveries done by cesarean in the USA has increased substantially in the past few years, from 20.7% in 1996 to 31.1% in 2006 [2]. "
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    ABSTRACT: Objective To evaluate the effectiveness of an intervention to adjust the indications for caesarean delivery in a Brazilian teaching hospital in accordance with a specific protocol. Methods The present before-and-after study was carried out in three stages. In stages 1 and 3, data were obtained for 160 cesarean deliveries that occurred between May 20 and July 10 in 2011 and 2012, respectively. For stage 2, the protocol was implemented for 12 months. The deliveries in stages 1 and 3 were classified as high or low risk, and as consistent or inconsistent clinical cases on the basis of the protocol. Results A total of 160 (61.1%; 95% confidence interval [CI] 55.2–67.0) of 262 deliveries in stage 1 were by cesarean, compared with 160 (71.4%; 95% CI 65.5–77.3) of 224 in stage 3 (P = 0.67). In stage 1, 125 (78.1%; 95% CI 71.7–84.5) showed indications consistent with the protocol, compared with 136 (85.0%; 95% CI 79.5–90.5) in stage 3 (P = 0.11). Among the low-risk cesarean deliveries, 27 (51.9%; 95% CI 38.3–65.5) of 52 were consistent with the protocol in stage 1, compared with 49 (72.1%; 95% CI 61.4–86.1) of 68 in stage 3 (P = 0.02). Conclusion The proposed intervention improved the suitability of indications for cesarean delivery among low-risk pregnancies only.
    International Journal of Gynecology & Obstetrics 10/2014; 128(2). DOI:10.1016/j.ijgo.2014.08.011 · 1.56 Impact Factor
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