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This book is the result of a consensus conference initiated because of increasing concern at the rapidly escalating rate of caesarian delivery. It is lengthy, 540 pages, but is easy to read, with clearly presented tables and straightforward statistics.
One of the areas covered by the book is an attempt to understand the epidemiology of caesarian birth. The rate trebled in the U.S.A. between 1968 and 1977 but all over the western world the rate of caesarian section is rising steadily although the birth rate is falling. This rise appears to be linked with an increased emphasis on hospital services and technology, because in the Netherlands where the emphasis is on early identification of at risk mothers and conservative management for the remainder, the rate of caesarian section is the lowest (the maternal mortality is lowest and infant mortality is lower than all the other reported countries except Norway).
The book then explores why this escalation has occurred, the problems medical, obstetric and neonatal that have tended to this change in clinical practice. The most important factors appear to be a) Dystocia:—that is problems of unco-ordinate uterine action and/or suspected cephalopelvic disroportion, and b) repeat caesarian because the first delivery was by caesarian section. They are thereby distinguishing between medical emergencies needing a caesarian section, which have remained at much the same level, and a second and increasing group of sections done for less well defined reasons, which of themselves then lead to further caesarian sections.
Of particular interest are the sections on the effects of caesarian birth on the mother, family and infant. As in my own study, there were no gross differences detected in the infants’ behaviour and development as compared with vaginally delivered infants. One of the most striking findings was the greater involvement of fathers where the baby was delivered by caesarian section, the fathers being more responsive to the child