Potential avoidability of planned cesarean sections in a French national database

Objective. To study the frequency and determinants of potentially avoidable planned cesarean sections, with a classification based on their indications, maternal obstetric history, and information about the current pregnancy. Design. Cross-sectional population-based study. Setting. All maternity units in France (n = 535). Population. A total of 14 681 women from the 2010 French National Perinatal Survey, a routine survey of a representative sample of births. Methods. Planned cesareans were classified in two groups: potentially avoidable and unavoidable. The classification was based on the French national guidelines and used data from medical records. We used logistic regression analyses to compare characteristics of the mothers with potentially avoidable cesareans with those of women who had a trial of labor. Analyses were performed separately in primiparas and multiparas. Main outcome measure. Rate of potentially avoidable planned cesarean sections. Results. The overall planned cesarean rate was 10.9%; 28% of these cesareans were found to be potentially avoidable. Breech presentation and history of one previous cesarean accounted for 83% of them. Determinants of potential avoidability were maternal age >35 years, intensive surveillance during pregnancy, and private status of the unit [adjusted odds ratio (OR) 1.9, 95% CI 1.2-3.2 among primiparas; adjusted OR 2.5, 95% CI 1.5-4.3 among multiparas]. Obesity was also a significant determinant but only among multiparas (adjusted OR 2.7, 95% CI 1.9-3.8). No association was found with maternal social characteristics. Conclusion. Our results suggest a high proportion of potentially avoidable cesareans and highlight the associated obstetric situations. They can help to target policies aimed at reducing cesarean rates.