...included twelve physicians, one nurse midwife, one nurse, three professors, and one attorney. There were 18 speakers during this conference including obstetricians, a urogynecologist, a pediatrician, professors in statistics and epidemiology, a research analyst, and a health correspondent for PBS.

Following the conclusion of the conference a state-of-the-science statement was prepared as a summary of the conference and was made available to the media and the public. The goal of the conference was to assess the available scientific evidence that is relevant to the following four questions:

* What is the trend and incidence of cesarean delivery over time in the United States and other countries?

* What are the short-term (less than one year) and long-term benefits and harms to mother and baby associated with cesarean delivery by request, versus attempted vaginal delivery?

* What factors influence benefits and harms?

* What future research directions need to be considered to get evidence for making appropriate decisions regarding cesarean delivery on request or attempted vaginal delivery?

Trends in Cesarean Section

Not surprisingly, the trend since the 1970s has been an increase in the incidence of cesarean section, with a slight decline from the late '80s to mid '90s. The national cesarean rate in 2004 was 29.1 percent with the projected rate for 2005 even higher. The increase in primary cesareans parallels the total cesarean delivery rate. This means that the increase in the total cesarean delivery rate cannot be explained by the decreasing availability of VBAC.

The report states that the primary cesarean delivery is increasing in all ethnic and age groups. "In the absence of any increase in known clinical risk factors for primary cesarean delivery, it is plausible that some of the primary cesarean delivery increase is because of cesarean delivery on maternal request" (italics mine).

Though the report acknowledges that cesarean delivery on maternal request is not clearly and accurately documented in any existing studies or databases, the report estimates that 4-18 percent of cesarean deliveries in the United States and internationally are by maternal request, admitting, "but there is little confidence in the validity of these estimates." What the report fails to emphasize is that the statistics presented come from hospital discharge data and birth certificate records, both recognized as highly inaccurate means of data representation.

In response to the proposed ideal of a 15 percent cesarean delivery rate, the report states: "There is no consistency in this ideal, and artificial declarations of an ideal rate should be discouraged. Goals... should be based on maximizing the best possible maternal and neonatal outcomes, taking into account available medical and health resources and maternal...

NOTE: All illustrations and photos have been removed from this article.



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