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. 2006 May;96(5):867-72.
doi: 10.2105/AJPH.2004.052381. Epub 2006 Mar 29.

Maternal risk profiles and the primary cesarean rate in the United States, 1991-2002

Eugene Declercq  1 , Fay Menacker, Marian Macdorman
Affiliations

Maternal risk profiles and the primary cesarean rate in the United States, 1991-2002

Eugene Declercq et al. Am J Public Health. 2006 May.

Abstract

Objectives: We examined factors contributing to shifts in primary cesarean rates in the United States between 1991 and 2002.

Methods: US national birth certificate data were used to assess changes in primary cesarean rates stratified according to maternal age, parity, and race/ethnicity. Trends in the occurrence of medical risk factors or complications of labor or delivery listed on birth certificates and the corresponding primary cesarean rates for such conditions were examined.

Results: More than half (53%) of the recent increase in overall cesarean rates resulted from rising primary cesarean rates. There was a steady decrease in the primary cesarean rate from 1991 to 1996, followed by a rapid increase from 1996 to 2002. In 2002, more than one fourth of first-time mothers delivered their infants via cesarean. Changing primary cesarean rates were not related to general shifts in mothers' medical risk profiles. However, rates for virtually every condition listed on birth certificates shifted in the same pattern as with the overall rates.

Conclusions: Our results showed that shifts in primary cesarean rates during the study period were not related to shifts in maternal risk profiles.

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Figures

FIGURE 1—
FIGURE 1—
Overall and primary cesarean rates and primary cesarean rates among low-risk primiparous and multiparous women: United States, 1991–2002. Note. Rates are per 100 births. Low-risk mothers were defined as those with singleton, full-term (≥ 37 weeks) births involving vertex presentations.
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