CESAREAN-SECTION DELIVERY IN THE 1980S - INTERNATIONAL COMPARISON BY INDICATION

OBJECTIVE: We compared trends and current levels of cesarean section d elivery by indication in four countries to help us understand factors underlying national differences in obstetric delivery practice and ide ntify pathways to lower cesarean rates. STUDY DESIGN: We carried out a measurement of change in the use of cesarean delivery by indication i n Norway Scotland, Sweden, and the United States during intervals cent ered on 1980, 1985, and 1990. Indication for cesarean delivery was det ermined by a standard set of selection rules. RESULTS: The rate of gro wth of national cesarean section rates dropped significantly between t he time periods 1980 to 1985 and 1985 to 1990 in all four countries; i n Sweden this led to an actual decline in the cesarean section rate. F etal distress and previous cesarean section were important contributor s to cesarean section growth in three of the countries in 1980 to 1985 , but their contribution to growth dropped off sharply in 1985 to 1990 . By the 1990 interval, the overall rate ranged from 24% (United State s) to 11% (Sweden), and all four countries had similar cesarean sectio n rates for breech presentation, fetal distress, and ''other'' indicat ions. Cesarean section deliveries for previous cesarean section and dy stocia accounted for the substantially higher U.S. cesarean section ra te. CONCLUSIONS: Cesarean section rates are approaching stability in t he four countries and have declined in Sweden, Previous cesarean deliv ery and dystocia may be the major sources of future reductions in the U.S. cesarean rate. The Swedish example shows that it is possible to r educe a relatively low national cesarean section rate.