Changed indications for cesarean sections

Objective. The aim of this study was to investigate the indications for cesarean sections in the early 1990s as compared to the middle 2000s. Design. Retrospective cohort study. Methods. Data were collected from original obstetrical records in a tertiary hospital in 1992 and 2005. Results. The total cesarean delivery rate rose from 11% to 20%. The main indications for an elective cesarean in 1992 were a pathological fetal lie or a uterine factor. The dominant indication for an elective cesarean in 2005 was a psychosocial indication defined as maternal fear of childbirth or maternal request without any co-existing medical indication. Presumed fetal compromise and prolonged labor remained the main indications for urgent and emergency cesareans. No apparent alterations in population characteristics could be identified for these years. Conclusions. The increased rate of elective cesareans for psychosocial indications would reflect altered attitudes towards mode of delivery in the childbearing population and among obstetricians. We suggest that extended support from community antenatal care should be provided and that standardized keys aiding a physician in decision-making procedures concerning the cesarean section practice should be developed.