Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. However, the rapid increase in cesarean birth rates from 1996 to 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Cesarean birth can be life-saving for the fetus, the mother, or both in certain cases. Abstract: In 2011, one in three women who gave birth in the United States did so by cesarean delivery.
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