Recent trends in cesarean section rates in Ontario.

After increasing steadily for 15 years the cesarean section rate in Ontario stabilized at 20.2 per 100 deliveries in the fiscal years 1986-87 and 1987-88. An important factor in the stabilization was a decrease in the rate of repeat section. The diagnosis and management of dystocia and fetal distress continue to put upward pressure on the cesarean section rate, which is higher than would be expected if recent practice guidelines had been fully implemented. There is a need for further research into the appropriate management of labour and delivery and into more targeted techniques for bringing practice into line with appropriate standards of care.