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Synapse: January 10, 1980

Friday, January 9, 2015

From 35 Years Ago:

Vol. 24, No. 12, Jan. 10, 1980:

Today, it widely recognized that many cesarean sections are performed needlessly. The American Congress of Obstetricians and Gynecologists even issued a document in March 2014 titled "Safe Prevention of the Primary Cesarean Delivery".

Concerns about the increasing frequency of C-sections is nothing new. Thirty-five years ago, Michael Bader reported on this trend in the article "Area cesarean rate tripled in 20 year." He wrote, "In California as a whole, the rate rose from 4.8 per cent in 1960 to 15.4 per cent in 1977." According to the California Office of Statewide Health Planning and Development, 29.8 percent of deliveries were uncomplicated C-sections in 2013, a level that has remained steady for the past several years.

Bader observed that the use of C-sections varied greatly from hospital to hospital. "At Children's Hospital, for example, almost one quarter of the women are 'sectioned,' while at San Francisco General the rate is less than one in ten." To a lesser degree, such disparities remain today. At the Pacific Campus of California Pacific Medical Center--descendent of the Children's Hospital just mentioned--26.6 percent of deliveries were uncomplicated C-sections in 2013, compared to 15.3 percent at SFGH and 20.5 percent at UCSF Medical Center.

A few experts interviewed by Bader pinned some of the blame for this increased rate of C-sections on increased use of electronic fetal monitoring, which became nearly universal over the course of the 1970s, arguing that equivocal findings from this monitoring providing a justification for performing the C-section. Baden closed with the historical note: "Residents trained at UCSF in the 1950's will recall that in order to perform a Cesarean, one needed the permission of no less than the chairman of the department to do so. Today, the procedure is almost routine." And now, too routine.