An Analysis of Operative Delivery Practices Over 30 Years [11D

Abstract

INTRODUCTION: The aim of this study was to determine delivery practice changes over the past 30 years for singleton pregnancies as a means to elucidate the underlying causes of the rising cesarean section (c/s) rate over the last several decades. METHODS: Delivery data was collected at a medium-sized teaching hospital in Colorado, averaging 4,690 singleton births/year, over 34 years. The numbers of forceps, vacuums, breeches and c/s were recorded for 79,723 singleton deliveries, from alternating years between 1978 and 2012 with complete records available. RESULTS: C/s done for breech presentation remained largely stable, averaging 3% of all deliveries (range 2.09–3.9%). The rate of operative vaginal delivery significantly decreased from a high of 14.7% in 1978 to 2% in 2010. Pooling the number of all operative deliveries (cesarean and forceps/vacuums combined) for non-breech presentation, the overall rate of deliveries requiring an operative approach remained stable at 27.7% in 1978 and 28% in 2012, (average 25.8%). CONCLUSION: Our data suggests that an even trade-off between operative vaginal deliveries and laboring c/s has occurred during the 2nd stage of labor over the past 30 years. The decrease in operative deliveries and not the decrease in breech vaginal deliveries, accounts for the increase in c/s rates. This decrease in operative deliveries is not surprising and has been demonstrated in other studies. This is presumably due to lack of training and comfort using operative vaginal techniques, as well as concerns for morbidity to both the newborn and the mother.