The increasing rate of Cesarean section is an extremely complex issue. There are many medical causes for this increase, including the nationwide epidemic of obesity and the related conditions of excessively large babies, hypertension and diabetes; the increasing percentage of women who delay their decision to have a baby until over age 35; the increasing incidence of multiple births, particularly twins; lower parity; safer anesthesia and surgery; and an awareness of the catastrophic complications of uterine rupture resulting from attempts at vaginal birth after a previous Cesarean section (VBAC).

When evaluating the rising Cesarean section rate, there are also many non-medical variables to consider. As documented by the March 2010 consensus statement from the National Institutes of Health Conference on Vaginal Birth after Cesarean, the current status of our tort system as it relates to professional liability and the real threat of a lawsuit in adverse outcomes have a major impact on the willingness of healthcare institutions and physicians to assume even acceptable complication rates in the laboring patient, particularly after a prior Cesarean birth or the birth of large babies. Obstetricians are rarely sued for performing a Cesarean birth, but they are often sued for "failure to perform a timely Cesarean section," a phrase that is all-too-common in malpractice lawsuit documents. There are multiple other non-medical explanations for the rise in the Cesarean section rate, including more stringent guidelines by professional associations such as ACOG requiring major changes in provider availability, surgical and anesthesia capability in order to allow for a relatively safe trial of labor after a Cesarean birth. These guidelines may not be practical or possible for many solo practitioners and smaller obstetrical services. As a result of these guidelines, the awareness of occasional catastrophic complications and their medical and legal consequences has led to a significant decline in VBAC.

Another major non-medical factor in the increasing Cesarean rate and the declining VBAC rate is high patient expectations in conjunction with increasing legal obligations that require physicians to document informed decision-making by their patients. Because it identifies the risks associated with a vaginal versus a Cesarean delivery, this practice of informed consent often discourages the patient from attempting a vaginal delivery.

Florida obstetricians seek the assistance of all stakeholders, citizens, legislators and responsible members of the media in our ongoing efforts not only to lower premature and Cesarean birth rates, but also to reach the more lofty goals of reducing maternal and perinatal mortality and morbidity in our state.

SOURCE American Congress of Obstetrics and Gynecology (ACOG)