“A perfect storm of medical, legal and personal choice issues.” More on the record high C-section rates:

The increase in primary C-sections and decrease in VBACs continue a trend established in the mid-1990s, the report noted. In 1996, C-sections accounted for just more than 20% of all U.S. births, with primary C-sections constituting about 13% of the surgeries. At the same time, VBACs rose to about 28% of births to women with a prior C-section. But since 1996, VBACs have declined sharply while C-sections have steadily increased.

The numbers are the result of a “perfect storm” of medical, legal, and personal choice issues, according to Dr. Bruce L. Flamm, area research chairman and a practicing ob.gyn. at the Kaiser Permanente Medical Center in Riverside, Calif. “All the forces are pointing toward higher C-section rates,” he said in an interview.

Increased intrapartum information available through electronic fetal monitoring can combine with malpractice worries to sway some ob.gyns. toward suggesting a C-section. “During labor, most ob.gyns. have in the back of their minds that any of the little blips on the monitoring strip could be used in a legal claim,” Dr. Flamm said. “While scientifically, there’s not much basis for that, it can sound good in a court of law.”