Do obstetric complications explain high caesarean section rates among women over 30?
As a growing proportion of women delay childbearing into their later reproductive years, the risks and costs associated with advancing maternal age become increasingly important. Extensive evidence shows that both obstetric interventions and obstetric complications are more common among older women,1 and it is often assumed that the interventions are a consequence of the complications. Delivery by caesarean section is one such intervention that is associated with maternal age and is of importance for public health. The extent to which the association is explained by obstetric complications is, however, not known. Martel et al showed that an association between maternal age and rates for primary caesarean section persisted after adjustment for induction of labour, epidural anaesthesia, meconium stained amniotic fluid, and fetal distress.2 We aimed to build on this finding by considering a greater number of obstetric complications in a much larger population and with more detailed record
