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Rates of caesarean delivery as a percentage of all live births have increased in all OECD countries in recent decades, although in a few countries this trend has reversed over the past few years. Reasons for the increase include reductions in the risk of caesarean delivery,
malpractice liability concerns, scheduling convenience for both physicians and patients, and changes in the physician‐patient relationship, among others. Nonetheless, caesarean delivery continues to result in increased maternal mortality, maternal
and infant morbidity, and increased complications for subsequent deliveries (Minkoff and Chervenak, 2003; Bewley and Cockburn, 2002; Villar et al., 2006). These concerns, combined with the greater financial cost (the average
cost associated with a caesarean section is at least two times greater than a normal delivery in many OECD countries; Koechlin et al., 2010), raise questions about the appropriateness of some caesarean delivery that may not be medically required.