Conclusion
Much of the increase in the caesarean delivery rate between 1989 and
2016 is explained by changes in maternal demographics and history of
caesarean delivery and a significant proportion is explained by changes
in the route of delivery for multiple gestation, malpresentations, and
preterm births. Planned caesarean delivery for maternal choice had
minimal impact.
Disclosure of interests The primary author was supported by an Early Career Fellowship grant
from the Australian Government National Health and Medical Research
Council whilst conducting this research.
Contribution to authorship
BdV conceived and designed the study and analysed the data. BdV, RM,
AEB, PK collected data. BdV and RM wrote the first draft of the
manuscript. All authors critically revised and contributed to the
manuscript for publication. We certify that all authors are responsible
for the content of the article and have read and approved the final
version.
Details of ethics approval
This study underwent institutional board review and received ethics
approval from the Sydney Local Health District (RPAH Zone) ethics
committee (Protocol No
X16-0466) on April
17 2017.