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Child Health USA 2013 An illustrated collection of current and historical data, published annually.

Cesarean Delivery

Narrative

Cesarean delivery represents a potentially life-saving procedure for both mother and infant in cases of labor complications and health conditions that require early or immediate delivery.1 However, in the absence of medical indications, cesarean sections can pose avoidable risks, including longer maternal recovery, neonatal respiratory problems, and potentially severe complications in subsequent pregnancies.2,3 After increasing every year from 1996 to 2009, the U.S. cesarean delivery rate declined slightly between 2009 and 2010 from 32.9 percent to 32.8 percent and remained unchanged through preliminary data for 2012. Though no longer increasing, the current rate of about one in three births far exceeds the upper limit of 15 percent advised by the World Health Organization.4

Healthy People 2020 has set national objectives to reduce the cesarean delivery rate by ten percent among low-risk women giving birth for the first time and among low-risk women with a prior cesarean section.5 Low-risk is defined as non-breech, singleton deliveries at 37 weeks or more gestation. In 2011, among the 36 states and the District of Columbia that had implemented the 2003 revision to the standard birth certificate as of January 1st, 26.2 percent of low-risk women giving birth for the first time and 89.5 percent of low-risk women with a prior cesarean section delivered by cesarean. Cesarean delivery among low-risk, first births increased greatly with maternal age from 18.7 percent of women less than 20 years of age to 51.6 percent of women aged 40 and older. This pattern may partly reflect age-related increases in medical indications for cesarean delivery. However, the repeat cesarean rate among low-risk women was about 90 percent, regardless of maternal age.

Recently, cesarean delivery rates among low-risk pregnancies were found to vary fifteen-fold across U.S. hospitals from 2.4 percent to 36.5 percent, highlighting the importance of quality improvement and standardization in maternity care.6 To reduce cesarean delivery rates, there have been calls to expand public and provider education, to tie payments to quality improvement, and to publicly report hospital-level data.7,8

1 March of Dimes . C-Section: Medical Reasons. Accessed: 07/31/2013.

2 March of Dimes . C-Section: Medical Reasons. Accessed: 07/31/2013.

3 Cesarean delivery on maternal request. Committee Opinion No. 559. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013:121;904–7.

4 World Health Organization. Monitoring Emergency Obstetric Care: A Handbook. Geneva, Switzerland: World Health Organization Press. 2009

5 U.S. Department of Health and Human Services. Healthy People 2020 Topics & Objectives: Maternal, Infant, and Child Health. Accessed: 07/31/2013.

6 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, et al. Births: Final data for 2006. National vital statistics reports; vol 57 no 7. Hyattsville, MD: National Center for Health Statistics. 2009.

7 Kozhimannil KB, Law MR, Virnig BA. Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues. Health Aff (Millwood). 2013 Mar;32(3):527-35.

8 Main EK, Morton CH, Melsop K, Hopkins D, Giuliani G, Gould JB. Creating a public agenda for maternity safety and quality in cesarean delivery. Obstet Gynecol. 2012 Nov;120(5):1194-8.

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Graphs

This image is described in the Data section.

Cesarean Delivery rates graph

This image is described in the Data section.

Cesarean Delivery rates by age graph

Data

Cesarean Delivery Rate, 1990-2012 Data for 2012 are preliminary
Year Percent of Live Births Delivered by Cesarean Section
Source: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2012. National vital statistics reports; vol 62 no 3. Hyattsville, MD: National Center for Health Statistics. 2013.
Source: Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2011. National vital statistics reports; Vol 61 no 1. Hyattsville, MD: National Center for Health Statistics. 2013.
1990 22.7
1991 22.6
1992 22.3
1993 21.8
1994 21.2
1995 20.8
1996 20.7
1997 20.8
1998 21.2
1999 22.0
2000 22.9
2001 24.4
2002 26.1
2003 27.5
2004 29.1
2005 30.3
2006 31.1
2007 31.8
2008 32.3
2009 32.9
2010 32.8
2011 32.8
2012 32.8
Primary and Repeat Cesarean Delivery Rates Among Low-Risk Women,* by Age, 2011
Age of Mother Percent of Women with Primary Cesarean Among First Births Percent with Repeat Cesarean Among Women with Prior Cesarean
*Low-risk is defined as non-breech, singleton deliveries at 37 weeks or more gestation. Data are from 36 states and the District of Columbia that implemented the 2003 revision of the birth certificate as of January 1, 2011, representing 83% of all U.S. births.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. 2011 Natality File. Analysis conducted by the Maternal and Child Health Bureau.
Less Than 20 Years 18.7 90.6
20-24 Years 23.7 90.6
25-29 Years 27.2 89.3
30-34 Years 31.9 89.1
35-39 Years 40.7 89.6
40 Years and Older 51.6 89.6
Total 26.2 89.5