Cesarean rates UP since the 70s and 80s... AND...?

Countless articles, news reports and media interviews begin with an introduction along these lines... "Back in the 1980, the CS rate was just X but today it's risen to Y. Evidently, this is bad."

But surely the CS rate is not all that readers and listeners need or want to know? For example, why not inform them that over the same period, rates of infant deaths have decreased significantly.

The neonatal mortality rate fell by 62%, from 7.7 deaths per 1,000 live births in 1980 to 2.9 in 2010, and the perinatal mortality rate (which includes stillbirths)* fell by 44% from 13.3 deaths per 1,000 total births in 1980 to 7.4 in 2010.

*in October 1992, the legal definition of a stillbirth was changed to include deaths after 24 completed weeks of gestation or more, instead of after 28 completed weeks of gestation or more. Therefore improvements in perinatal mortality outcomes may be even greater than that shown above.

Other birth outcomes

Pregnant women may also like to know that in the last year alone, rates of complications such as perineal laceration (39.9%), long labour (10.3%) obstructed labour, fetal distress and umbilical cord-related complications (30.5%), episiotomies (15.2%) and instrumental vaginal deliveries (13%) have all increased.

All of these outcomes can be directly associated with serious infant and maternal morbidity, so to assume that the caesarean rate - high or low - can somehow be the most important indicator of marternity health outcomes over a given period, is a very limited view in my opinion.