Maybe we’re just where we want to be with the C-section rate
Based on the WHO report cited here, clinicians in the United States can be assured that this country has neither the lowest nor the highest rate of cesarean delivery in the world. So it’s reasonable to conclude that, given today’s medical and cultural environment, the US rate of cesarean delivery rate may not be too low and may not be too high. It may be just about right.
ROUTE OF FIRST DELIVERY INFLUENCES CHOICE OF ROUTE SUBSEQUENTLY
In Massachusetts in 2006, among women with a singleton pregnancy who had never delivered previously, approximately 70% delivered vaginally and 30% delivered by C-section. In a second or succeeding pregnancy, among women who had a history of vaginal delivery in their previous pregnancy, the delivery route was 90% vaginal and 10% cesarean. In a second or succeeding pregnancy among women who had a history of a cesarean delivery in the previous pregnancy, delivery route was 90% cesarean and 10% vaginal.
Clearly, the route of first delivery heavily influences the route of second and all subsequent deliveries. When a first birth is by cesarean delivery, subsequent deliveries are all likely to be a C-section, and the likelihood of cesarean delivery increases with each succeeding repeat cesarean delivery.1
Consequently, extra effort is warranted to ensure a vaginal delivery with the first birth for women who intend to have three or more children. This will maximize the likelihood of subsequent vaginal delivery. For women who intend to have only one or two children, however, it isn’t as critical to take any unnecessary risks during a first labor to achieve vaginal delivery—because having only one or two cesarean deliveries is associated with less cumulative surgical risk.