Experts say cesarean section rates are headed 'Sky-High'. (Fewer VBACs Cited as One Factor).

VAIL, COLO. -- Cesarean section rates are headed up, up, and away.

"I suspect that the cesarean section rate is probably going to double by the next generation," Dr. Ronald S. Gibbs predicted at a conference on obstetrics and gynecology sponsored by the University of Colorado.

The total cesarean delivery rate has climbed steadily from 20.7% in 1996 to 22.9% in 2000, according to data from the Centers for Disease Control and Prevention in Atlanta.

Dr. Gibbs and other speakers cited multiple contributing factors. A major one is the American College of Obstetricians and Gynecologists' recent recommendation that vaginal birth after cesarean (VBAC) section be attempted only if physicians are "immediately available" to provide emergency care. That's already having a chilling effect.

In addition, the recent ACOG practice bulletin recommending against planned vaginal delivery of singleton breech presentations will cause a bump in C-section rates. However, the effect will be small because three-quarters of such cases are already managed by planned C-section.

A bigger contributor to increased cesareans will be the patient choice issue, with a growing number of women opting for C-section to avoid perineal dysfunction after vaginal delivery, said Dr. Gibbs, the E. Stewart Taylor Chair and professor of ob.gyn. at the university in Denver.

There is no mistaking ACOG's intent in recommending that VBAC be restricted to settings where physicians are "immediately available" for emergent operative delivery, he said. "I don't think 'immediately available' means you're in your office six blocks away or you're at home. I think it means your backside is in the hospital," he emphasized.