Objective: To examine the factors accounting for the increase in rate of cesarean section, between 1983 and 1993 (from 13.0% to 19.5%) in Toulouse University Hospital, a tertiary level center.
Design: Retrospective study of all single deliveries, excluding deaths in utero, between 1983 and 1993.
Results: Half the increase in overall rate was due to the numerical increase in women with a cesarean section history. The percentage of cesarean sections in these patients remained constant at 79% over this period. For the other patients, the increase in rate was due partly to an increase in risk factors, but mainly to a change in obstetric practice with a marked increase in elective cesarean section (70% of all cesarean sections in 1993). Major complications in the mothers were relatively rare, albeit significantly more frequent in the cesarean cases. Over the study period the percentage of infants requiring intensive care remained constant for the vaginal deliveries but declined for the cesarean sections.
Conclusion: The increased rate of cesarean sections has not led to any increase in maternal complications, and appears to have had a small favorable influence on infant morbidity.