Trends in cesarean birth and vaginal birth after previous cesarean, 1991-99

Abstract

Objectives: This report presents trends in rates of cesarean delivery and rates of vaginal birth after previous cesarean (VBAC) delivery for 1991-99. Data for the United States showing trends by maternal age, race/ethnicity, and State are presented. Also trends in cesarean rates by selected maternal characteristics, medical risk factors, and complications of labor and/or delivery are shown. A brief explanation of the Healthy People 2010 objective regarding cesarean and VBAC rates for low-risk women is also included. Summary statistics for 2000 based on preliminary data are also included, but most tabular and text information is based on detailed final statistics for 1999.

Methods: Cesarean and VBAC rates were computed based on the information reported on birth certificates.

Results: The U.S. cesarean rate dropped 8 percent between 1991 and 1996 (from 22.6 to 20.7 per 100 births) but then increased 6 percent between 1996 and 1999 (to 22.0); preliminary data show that the rate increased again by 4 percent between 1999 and 2000 (to 22.9). The decline between 1991 and 1996 was present for women of all ages but was most pronounced for those under 30 years of age. The decline was greatest for non-Hispanic white women, 10 percent, compared with a 7-percent decline for Hispanic women and only a 1-percent decline for non-Hispanic black women. All groups experienced increases in cesarean rates of about 6 to 7 percent between 1996 and 1999. The increase in cesarean rates between 1996 and 1999 was greatest for women 30 years of age and over. The VBAC rate increased 33 percent between 1991 and 1996 (from 21.3 to 28.3 per 100 births to women with a previous cesarean) but then fell 17 percent between 1996 and 1999 (to 23.4). The dramatic increase in VBAC rates between 1991 and 1996, followed by the subsequent decline, was experienced by women of all ages and for each major race/ethnicity group. Similar trends in cesarean rates were present for nearly all States and for most medical risk factors and complications of labor and/or delivery.