Journal of Women's Health Care
Open Access

Cesarean Delivery

The rate of cesarean section (CS) has increased in many developed countries, the reasons being the high rate of CS in nulliparous women and the frequently repeated CS in women with a marked uterus. In fact, 27% to 76.5% of CS are performed in nulliparous women. Labor in these women is often associated with first and especially longer second stages, which increases the risk of instrumental deliveries and emergency SC. In nulliparous women, many of these CS are performed at the second stage. Studies have shown that a successful first vaginal delivery, although crucial, increases the chances of vaginal delivery during subsequent pregnancy, while a first delivery by CS has been associated with an increased risk of repeated CS in later deliveries. Reducing the rate of CS in nulliparous women could help reverse the increase in the rate of CS. Due to the fear of uterine rupture during the scar test, the repetition of CS is performed by many obstetricians, sometimes without clear indications. The repetition of SC contributes to the increase in the rate of SC, because future vaginal deliveries in these women will be almost impossible. This is why some authors have advised obstetricians to be patient during the second phase of labor in nulliparous women and the indication for primary (first) cesarean section should be absolute.