Rising caesarean section rate: a matter of concern?

Sanjivani A. Wanjari


Background: Caesarean section is the most commonly performed surgery in obstetrics. Newer indications have emerged over time for both maternal and foetal indications and this has resulted in a dramatic rise in caesarean section rate in the last several years.

Methods: A one year observational study was done in a large government hospital receiving a large number of patients from urban as well as rural areas and also referrals from the periphery. An attempt was made to find out the caesarean section rate and to evaluate the indications that lead to a rise in caesarean section rate.

Results: During the one year study period, there were total 14568 deliveries, out of which 5508 were caesarean sections giving a caesarean section rate of 37.8%. Repeat caesarean section after one prior caesarean delivery was the leading contributor of caesarean section rate and accounted for one in three caesarean sections carried out (32.80%). Other leading indications were foetal distress (9.36%), CPD (7.69%), PROM (7.31%), postdate pregnancy (6.62%), hypertensive disorders of pregnancy (6.0%).

Conclusions: Some of the measures that can reduce caesarean section rate can be 1) reduction in primary caesarean sections 2) giving the option of VBAC to women with one prior caesarean section 3) use of foetal heart tracings and scalp blood sampling for foetal monitoring 4) judicious use of oxytocin and plotting of the partogram for every labour. 


Caesareans section rate, Rising rate, Indications, Prior one caesarean

Full Text:



WHO. Appropriate technology for birth. Lancet. 1985; ii:436-7.

S. N. Mukherjee. Rising caesarean section rate. J Obstet Gynaecol India. 2006;4(56):298-300.

Sachs BP, Kobelin C, Castro MA, Frigoletto F. The risks of lowering caesarean-delivery rate. N Engl J Med. 1999;340:54-7.

Editorial. What is the right number of caesarean section? Lancet. 1997;349:815-6.

Reskin EC, Reine GM. Guest editorial - what is the correct caesarean section rate and how to get there. Obstet Gynaecol Surv. 2002;57:189-90.

Kambo I, Bedi N, Dhillon BS, Saxena NC. A critical appraisal of caesarean section rates at teaching hospitals in India. Int J Obstet Gynaecol. 2002;79:151-8.

WHO. CDS INAS Bulletin 1995-2003. Cited from: Christilaw JE. Cesarean section by choice: constructing a reproductive rights framework for the debate. Int J Gynaecol Obstet. 2006;94:262-8.

Guise JM, Barlin M, McDonagh M, Oserweil P, Cham B, Helfand M. Safety of vaginal birth after caesarean. A systematic review. Obstet Gynaecol. 2004 Mar;103(3):420-9.

National Institutes of Health Consensus Development Conference Statement. Vaginal birth after caesarean: new insights March 8-10, 2010. Obstet Gynaecol. 2010;115(6):1279-95.

McMahon MJ, Luther ER, Bowles WA Jr, Olshan AF. Comparison of trial of labour with an elective caesarean section. N Engl J Med. 1996;335(10):689-90.

Anderson GM, Lomas J. Determinants of increased caesarean birth rate. Ontario data 1979-82. N Engl J Med. 1984 Oct 4;311(14):887-92.

Shamshad. Factors leading to increased caesarean section rate. Gomal J Med Sci. 2008 Jan-Jun;6(1):1-5.