Objective: Our purpose was to examine the indications for performing cesarean sections in current obstetric practice and to define and measure the true contribution of dystocia ("difficult labor") to the overall cesarean section rate.
Study design: A prospective audit was done of all cesarean sections performed during 1991 at The Queen Mother's Hospital, Glasgow, a teaching hospital and tertiary referral center.
Results: The cesarean section rate for 1991 was 16.3%. Dystocia was the primary indication in 16% of all cesarean sections in 1991 but was actually a contributing factor, directly or indirectly, in the decision to operate in up to 38% of all cesarean sections that year. Seventy-eight percent of patients delivered because of dystocia were in spontaneous labor. We advocate more widespread use of a policy of active management in nulliparous women who labor spontaneously. If dystocia is addressed successfully, then many repeat cesarean sections may also be avoided.
Conclusions: Improved management of dystocia in nulliparous women, such as the use of a policy of active management of labor, may be the most useful approach to reducing the cesarean section rate in modern obstetric practice.