Caesarean section dissected, 1978–1983

TLDR

Dystocia is a major determinant of future caesarean section rates, though a causal link has not been established. Between 1978 and 1983, 10 % of Oxford singleton births were by caesarean section with no temporal trend, repeat sections comprising 30 % of all, and the main indications—dystocia, fetal distress, and breech—accounting for 45 % of cases; compared with North America, repeat and dystocia rates were lower but other indications were similar.

Abstract

Of 32735 singleton births in Oxford in the 6 years 1978-1983, 10% were by caesarean section. In contrast to the national data, no trend in this rate was observed. Repeat caesarean sections accounted for 30% of all sections and the proportion of women who had had a previous caesarean section rose gradually in the hospital population. The other main indications for section were dystocia, fetal distress in labour and breech presentation, which together accounted for a further 45% of all sections. Comparison with caesarean section rates reported from North America shows that repeat sections and sections for dystocia were less frequent in Oxford but the rates for other indications were similar. Dystocia is likely to be a key factor in determining future section rates. Dystocia occurred mainly in primiparae, and was more common with short stature and with increasing gestation and maternal age. For all height, age and gestation groups dystocia was more than twice as frequent in induced as in non-induced labour. This association does not imply a causal relationship, but neither is one excluded.