Abstract
The cesarean delivery rate has been raising nonstop for over three decades [1]. In the United States, in the year 2011, one-third of women who gave birth had a cesarean delivery [2]. This trend has been verified not only in the United States but also worldwide. The steady increase number of cesarean deliveries is due to multiple factors including the relative perceived safety of cesarean delivery operation in modern medicine [3]. Other important factors that resulted in a higher cesarean section rate are that there has been a constant decrease rate of operative vaginal deliveries, vaginal delivery of twin with cephalic presentation, vaginal breech deliveries, vaginal birth after cesarean section (VBAC), and medicolegal concerns for possible complications as a result of bad outcomes in patients attempting VBAC [3]. Unfortunately, this rapid increase of cesarean births has not resulted in decreased neonatal morbidity or mortality, which raises significant attention on the possible overuse of cesarean birth [4]. A concern about the uncontrolled raise of cesarean sections was recognized in the early 1970s [5]. An epidemiologic study revealed that “severe” maternal complications such as hemorrhage that required hysterectomy or massive blood transfusion, uterine rupture, anesthetic complications, shock, venous thromboembolism, cardiac arrest, acute renal failure, assisted ventilation, major infection, and wound disruption were threefold increased for cesarean delivery as compared with vaginal delivery [6]. Also, well-known long-term effects of cesarean deliveries such as infertility, pelvic adhesions, and pelvic pain have been described in many textbooks [1]. Subsequent pregnancies have a documented higher rate of perinatal complications not only maternal but also neonatal complications such as prematurity, low Apgar scores, neonatal intensive care unit (NICU) admissions, and higher perinatal death.