ArticleBMJ open2012
Pathways to a rising caesarean section rate: a population-based cohort study.
Article in BMJ open, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review.BMC pregnancy and childbirth · 2015Pooled it
- Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis.BMC pregnancy and childbirth · 2013Pooled it
- Impact of epidural analgesia on outcomes of vaginal birth after cesarean delivery.Archives of gynecology and obstetrics · 2025Article
- Obesity and cesarean section rate among low-risk primiparous women in Victoria, Australia: A population-based study.Acta obstetricia et gynecologica Scandinavica · 2025Article
- Reducing caesarean section rates in Robson groups 1 and 3: a quality improvement initiative in a private Brazilian hospital.BMJ open quality · 2025Article
- Has the cesarean epidemic in Czechia been reversed despite fertility postponement?BMC pregnancy and childbirth · 2022Article
- Evaluation of factors that predict the success rate of trial of labor after the cesarean section.BMC pregnancy and childbirth · 2021Article
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- The relationship between midwife-led group-based versus conventional antenatal care and mode of birth: a matched cohort study.BMC pregnancy and childbirth · 2017Article
- Rates and trends in cesarean sections between 2008 and 2012 in Iraq.BMC pregnancy and childbirth · 2017Article
- Are freestanding midwifery units a safe alternative to obstetric units for low-risk, primiparous childbirth? An analysis of effect differences by parity in a matched cohort study.BMC pregnancy and childbirth · 2017Article
- Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh.PloS one · 2017Article
- Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands.BMC pregnancy and childbirth · 2016Article
- First birth cesarean proportion: A missed indicator in controlling policies.Medical journal of the Islamic Republic of Iran · 2016Article
- The impact of obstetric mode of delivery on childhood behavior.Social psychiatry and psychiatric epidemiology · 2015Article
- Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study.BMC pregnancy and childbirth · 2015Article
- Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures.BMC pregnancy and childbirth · 2015Article
- Varying gestational age patterns in cesarean delivery: an international comparison.BMC pregnancy and childbirth · 2014Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine whether the obstetric pathways leading to caesarean section changed from one decade to another. We also aimed to explore how much of the increase in caesarean rate could be attributed to maternal and pregnancy factors including a shift towards delivery in private hospitals.
designPopulation-based record linkage cohort study.
settingNew South Wales, Australia.
participantsFor annual rates, all women giving birth in NSW during 1994 to 2009 were included. To examine changes in obstetric pathways two cohorts were compared: all women with a first-birth during either 1994-1997 (82 988 women) or 2001-2004 (85 859 women) and who had a second (sequential) birth within 5 years of their first-birth. PRIMARY OUTCOME MEASURES: Caesarean section rates, by parity and onset of labour.
resultsFor first-births, prelabour and intrapartum caesarean rates increased from 1994 to 2009, with intrapartum rates rising from 6.5% to 11.7%. This fed into repeat caesarean rates; from 2003, over 18% of all multiparous births were prelabour repeat caesareans. In the 1994-1997 cohort, 17.7% of women had a caesarean delivery for their first-birth. For their second birth, the vaginal birth after caesarean (VBAC) rate was 28%. In the 2001-2004 cohort, 26.1% of women had a caesarean delivery for their first-birth and the VBAC rate was 16%. Among women with a first-birth, maternal and pregnancy factors and increasing deliveries in private hospitals, only explained 24% of the rise in caesarean rates from 1994 to 2009.
conclusionsRising first-birth caesarean rates drove the overall increase. Maternal factors and changes in public/private care could explain only a quarter of the increase. Changes in the perceived risks of vaginal birth versus caesarean delivery may be influencing the pregnancy management decisions of clinicians and/or mothers.
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