Our goal was to determine prevalence of counseling and interventions performed to reduce the cesarean birth rate.METHODS:
Retrospective cohort study of 1,115 primary cesarean deliveries (CD) at Magee Women's Hospital in 2011. Demographics, prenatal counseling, labor progress and intrapartum procedures, were abstracted from the electronic medical record. Descriptive statistics were used to describe the frequency of counseling and/or interventions.RESULTS:
Of 1,115 primary CDs, 102 (9%) were for failed induction of labor (IOL), 286 (24%) for first stage, 237 (21%) for second stage arrest, 310 (28%) for a non-reassuring fetal heart rate, 162 (15%) for breech presentation, 65 (6%) for macrosomia, 44 (4%) for twins, 104 (9%) other medical indications, and 34 (3%) did not have an indication documented in the medical record. Of 237 CDs performed for second stage arrest, operative delivery was attempted in 18 (8%) and 84 (35%) met arrest criteria adjusted for parity. Among 102 CDs performed for a failed IOL, 38 (37%) received oxytocin for at least 12 h after rupture of membranes and 71 (70%) used cervical ripening in patients' with a Bishops score less than six. Among 213 CDs performed for arrest of dilation >6 cm, 167 (78%) had an IUPC during labor. Of 65 CDs for macrosomia, 47 (72%) had documented evidence of macrosomia by ultrasound. Of 162 CDs performed for breech presentation, 70 (43%) documented counseling for external cephalic version and 20 (12%) attempted version.CONCLUSION:
Many primary cesarean sections are performed without utilization of interventions designed to reduce the CD rate.