[How can we prevent a further increase in the rate of cesarean sections in the Czech Republic?].

In countries with a high rate of Caesarean sections (SC) and a low perinatal mortality rate provisions are made to prevent a further increase of the rate of SC. The reason is the 4-8 times higher maternal mortality rate in SC than after vaginal delivery and the declining effectiveness of an increased rate of SC on further reduction of the perinatal mortality, if the rate of SC exceeds 10%. In the Czech Republic the nationwide mean frequency of SC in 1994 has surpassed this range (10.5% SC). A rapid rise of the rate of SC in the CR occurred in maternity homes in the field, where this upper borderline should be by 3-4% lower, as well as in perinatological centres where it should not be higher than 15%. Because investigations abroad provided evidence that mere publicity drawing attention to the mentioned risks of a rising frequency of SC does not suffice to stop the increase, the author submits proposals for professional, organizational and control measures.