Managing the primary cesarean delivery rate

Clin Obstet Gynecol. 2012 Dec;55(4):946-60. doi: 10.1097/GRF.0b013e318263c547.


One third of deliveries in the United States are by cesarean, a rate that far exceeds that recommended by professional organizations and experts. A dominant reason for the high overall cesarean rate is the rising primary cesarean rate. The high primary cesarean rate results from multiple factors, both clinical and nonclinical. This review outlines proposed interventions to lower the primary cesarean rate. We focus on those implementable at a facility level and would likely yield immediate results, including aligning provider incentives for vaginal birth, limiting elective induction of labor, and improving labor management of dystocia and abnormal fetal heart rate tracings.

Publication types

  • Review

MeSH terms

  • Breech Presentation / therapy
  • Cesarean Section / economics
  • Cesarean Section / legislation & jurisprudence
  • Cesarean Section / statistics & numerical data*
  • Cesarean Section / trends*
  • Delivery, Obstetric / economics
  • Delivery, Obstetric / education
  • Dystocia / surgery*
  • Dystocia / therapy
  • Fees and Charges
  • Female
  • Fetal Distress / diagnosis*
  • Fetal Distress / surgery
  • Humans
  • Midwifery
  • Patient Education as Topic
  • Physicians / economics
  • Pregnancy
  • United States