Rising caesarean section rate: a matter of concern?

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.