Intended for healthcare professionals


Making sense of rising caesarean section rates

BMJ 2004; 329 doi: (Published 23 September 2004) Cite this as: BMJ 2004;329:696
  1. Geoffrey M Anderson, professor (
  1. Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 12 Queens Park Crescent West, Toronto, Canada M5S 1A8

    Time to change our goals

    In Canada and the United States the appropriate role of caesarean section was an important women's issue, a topic for research on patterns of use, and a target of professionally endorsed guidelines in the early 1980s. Two decades later women, researchers, and the medical establishment are once again debating the use of this procedure.

    Rather than being a case of history repeating itself, the current debate is different in content and tone. Historically, as caesarean section rates rose and crossed the 15% mark that the World Health Organization had suggested as an upper limit, research focused on determining the extent to which the increase was driven by medical indications.1 The medical profession defined approaches to care that would reduce or limit the rise in caesarean section, and systematic efforts were made to implement these strategies.2 Currently, caesarean section rates in Canada and the United States are close to 25% and over 20% in England, Wales, and Northern Ireland.3

    Recent articles in leading journals support offering women, in whom an accepted medical indication for …

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