Repeat cesareans: how many are elective?

Indications for cesareans using hierarchies based on ICD-9 codes do not attempt to differentiate categories of indications for repeat cesarean. Current recommendations for lowering cesarean rates by increasing vaginal birth after previous cesarean are based on aggregate data and do not recognize that some repeat cesareans are clinically indicated. A coding system designed to distinguish elective from indicated repeat cesareans would be useful for future prospective studies.