Context

In March 2014, the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine published ‘Safe prevention of the primary cesarean delivery’.1 The impetus for this statement was the rapid increase in caesarean deliveries from 1996 to 2011 without concomitant improvement in obstetric outcomes.2 ,3 These findings raise concern that medically unnecessary caesarean deliveries are being performed in the USA. The long-term reproductive risks of successive repeat caesarean deliveries have also helped shift the focus to the prevention of unnecessary primary caesarean deliveries.4 …