Reversing the upward trend in the cesarean section rate.

The incidence of the main indications for cesarean sections in the last 20 years was analysed. Starting in 1981, we changed our attitude to cesarean sections and gradually initiated various means of decreasing our overall cesarean section rate. As a result, our increasing section rate was reversed in two phases: first by halting the upward trend, plateauing around 12%, followed by a 20% decrease to 9.7% in 1985. The change was in both the primary section rate and the repeat rate. The major decrease was in breech indication (1.2% vs. 2.8%), as a result of more external cephalic versions and fewer elective sections for this indication. By allowing more trials of labor after a prior cesarean section, combined with the reduction in the primary cesarean sections, a decrease in the repeat cesarean sections was noted (2.6% vs. 3.7%). By preventing the self-perpetuation of repeat sections, a reduction in multiple repeat sections is expected in the future. The intrapartum fetal mortality rate was not affected by the decreasing cesarean section rate. A further decrease in our cesarean section rate is expected in the future.