Cesarean Section without Medical Reason, 1997 to 2006: A Swedish Register Study

ABSTRACT: Background: Cesarean section performed in the absence of medical indicationis of concern in many countries, but studies focusing on its prevalence are inconclusive. Theobjective of this study was, first, to describe the prevalence of cesarean section without medicalreason in terms of the diagnostic code listed in the Swedish Medical Birth Register, and toassess its contribution to the general increase in the number of cesarean sections; and second,to study regional differences and differences in the maternal characteristics of women having acesarean birth with this diagnostic code. Methods: Birth records of 6,796 full-term cesareansections in two Swedish regions with the diagnostic code O828 were collected from the SwedishMedical Birth Register. Descriptive data, t test, and logistic regression analysis were used toanalyze data. Results: The rate of cesarean sections without medical indication increasedthreefold during the 10-year period, but this finding represents a minor contribution to the gen-eral increase in the number of cesarean sections. The diagnostic code O828 was more commonin the capital area (p<0.001). Secondary diagnoses were found, the most frequent of whichwere previous cesarean section and childbirth-related fear. Regional differences existed con-cerning prevalence, classification, maternal sociodemographic, obstetric, and health vari-ables. Conclusions: The rate of cesarean sections without medical reasons in terms of thediagnostic code O828 increased during the period. The prevalence and maternal characteris-tics differed between the regions. Medical code classification is not explicit when it comes todefining cesarean sections without medical reasons and secondary diagnoses are common.(BIRTH 37:1 March 2010)Key words: cesarean section without medical reason, medical code classification, registerstudy