The continually rising cesarean birth rate is of increasing concern to both the medical profession and the public. In the United States, the rate nearly tripled between 1970 and 1978. and in Canada, it more than doubled during the 1970s.It is important to understand the factors underlying this increase, especially the indications that contribute to it. The present authors have analyzed the records of 454,668 births in Ontario from 1979 to 1982 and compared their findings to data from other sources. They have given particular attention to the four indications which account for most cesarean deliveries, namely, previous cesarean birth, breech presentation, dystocia. and fetal distress.As shown in Table 1. the cesarean birth rate in Ontario increased from 16.5 per 100 deliveries in 1979 to 18.7 per 100 in 1982. an increase of over 13 per cent. Before attributing the increase to either more diagnoses of indications or larger numbers of patients with each indication, the authors considered two alternative explanations.
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