IS A RISING CESAREAN-SECTION RATE INEVITABLE

Objective To determine the indications for singleton caesarean section s in Scotland in 1994. Design Prospective survey of singleton caesarea n sections using information provided by clinicians entering data onto a computer in labour wards. Setting Twenty-three consultant-led obste tric units in Scotland. Population Women undergoing caesarean section in participating Scottish maternity units during 1994. Results Using r outinely collected data it was found that the caesarean section rate v aried by maternal age, parity, gestation, history of previous section and hospital of delivery, but there was no difference by area of depri vation. 87.4% (8369/9573) of Scottish caesarean sections were included in the survey of which 8098 were in women with singleton pregnancies. Most singleton caesarean sections were undertaken in primiparae (50.5 %), 31.2% were in women with a history of previous section and 18.3% w ere in multiparous women who had not had a previous section; 38.9% of the operations were elective, 13.9% were emergencies before labour and 47.2% were emergencies during labour. Four main indications-elective section for breech presentation (10.7% of all sections); emergency cae sarean section before labour because of fetal problems (2.8%); emergen cy caesarean section during labour for fetal distress and/or failure t o progress (30.3%); repeat section for reasons other than above (16.2% ) accounted for 60% of all caesarean sections in women with no other r ecorded complications. 7.7% of all singleton caesarean sections (19.8% of elective operations) were associated with maternal request for the operation. Discussion The survey has identified why caesarean section s are performed by Scottish obstetricians and highlighted some areas w here there would be scope to increase the vaginal delivery rate. Befor e this can be attempted, agreement must be reached by clinicians about effective management of particular problems. Women also need to have ready access to evidenced-based information about caesarean section.