Clapp Mark A, Barth William H
Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
Clin Obstet Gynecol. 2017 Dec;60(4):829-839. doi: 10.1097/GRF.0000000000000325.
The US cesarean delivery rate remains 30%-32%. Increases in maternal age, obesity, and diabetes put upward pressure on this rate. Alternatives to cesarean delivery, vaginal birth after cesarean (VBAC), and operative vaginal delivery, are underutilized and there are substantial challenges to their resurgence. Practice guidelines offer promise, but demonstrate only minor reductions in cesarean delivery. We estimate that the overall rate in the US will remain 27%-30% for the immediate future. As more states move to recognize the independent practice of midwifery and more payers seek lower cost options for childbirth, we anticipate the overall rate will drop to 20% or 25%, but not for another 15 years or more.
美国的剖宫产率仍保持在30%-32%。产妇年龄增长、肥胖和糖尿病使这一比率面临上升压力。剖宫产的替代方式，如剖宫产后阴道分娩（VBAC）和阴道助产，未得到充分利用，且其再度兴起面临诸多重大挑战。实践指南虽带来了希望，但仅使剖宫产率略有下降。我们估计，在不久的将来，美国的总体剖宫产率将维持在27%-30%。随着越来越多的州开始认可助产士的独立执业，以及越来越多的支付方寻求成本更低的分娩选择，我们预计总体剖宫产率将降至20%或25%，但这至少需要15年或更长时间。
