1 INTRODUCTION

Cesarean birth (CB) is likely overused¹ as no evidence of benefit to newborn morbidity or mortality and increasing maternal morbidity and mortality have spurred national and global efforts to reduce its use.^{2, 3} The increasing risks to the birthing person are “a significant maternal health safety issue.”⁴ While potentially lifesaving, CB does have both short- and long-term risks for both mother and newborn.^5-7 In the United States (US), the CB rate has risen from 16.5% in 1980,⁸ to 20.7% in 1996,⁹ to >30% from 2005 to the present¹⁰ with a rate of 32.2% reported for 2022 and the first quarter of 2023.¹¹ Since 2012, labor management guidelines¹ have been a core tool designed to help lower the CB rate in the United States. In January 2024, the American College of Obstetrics and Gynecology (ACOG) reaffirmed labor management guidelines as the principal mechanism for reducing CB.²

And yet, publicly available data¹² show that 72% of all CB between 2016 and 2021 in the United States occurred among women and birthing people with no trial of labor in pursuit of vaginal birth. Because the ACOG guidelines by definition only reduce CB among individuals who labor, they necessarily exclude the majority of CBs. As such, the ability of these guidelines to reduce CBs is significantly diminished.

The purpose of this commentary is to describe the disconnect between where cesarean reduction efforts are focused and where the majority of cesareans are actually occurring in the United States. Next, I propose a strategy for collecting and reporting data that would enable a more thorough analysis of this disconnect and that might also indicate ways to eliminate it. I close with some reflections on associated issues surrounding the provision of maternity care in the United States today.

中文翻译：

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由于不尝试阴道分娩，剖腹产手术的效果会减弱

 1 简介

剖腹产（CB）可能被过度使用^1，因为没有证据表明剖腹产对新生儿发病率或死亡率有好处，而且孕产妇发病率和死亡率的增加促使国家和全球努力减少剖腹产的使用。 ^{2, 3}分娩者面临的日益增加的风险是“一个重大的孕产妇健康安全问题”。 ⁴ CB 虽然有可能挽救生命，但对母亲和新生儿来说确实存在短期和长期风险。 ^5-7在美国，CB 率从 1980 年的 16.5%、1996 年的⁸ % 上升到 20.7%，从 2005 年的⁹ % 上升到 30% 以上，再到现在^{10 年}，据报告，2022 年的比率为 32.2%， 2023 年第一季度。 ¹¹自 2012 年以来，劳工管理指南¹一直是旨在帮助降低美国 CB 率的核心工具。 2024 年 1 月，美国妇产科学院 (ACOG) 重申劳动管理指南是减少 CB 的主要机制。 ²

然而，公开数据¹²显示，2016 年至 2021 年间，美国 72% 的 CB 发生在女性和未尝试阴道分娩的待产人群中。因为根据定义， ACOG 指南仅减少劳动者中的 CB，因此它们必然排除了大多数 CB。因此，这些指南减少 CB 的能力显着减弱。

本评论的目的是描述美国减少剖腹产手术的重点与大多数剖腹产实际发生的地方之间的脱节。接下来，我提出了一种收集和报告数据的策略，该策略可以对这种脱节进行更彻底的分析，并可能指出消除这种脱节的方法。最后，我对当今美国提供产妇护理的相关问题进行了一些思考。