Primary Cesarean Delivery Rates Edge Down in 2012, Data Show

Troy Brown, RN

January 23, 2014

Primary cesarean delivery rates declined modestly from 2009 to 2012 but have remained unchanged in many states, according to a report published online January 23 in the Centers for Disease Control and Prevention's (CDC's) National Vital Statistics Reports.

Michelle J.K. Osterman, MHS, from the Division of Vital Statistics, CDC, National Center for Health Statistics, Hyattsville, Maryland, and colleagues analyzed data from states and areas that used the 2003 US Standard Certificate of Live Birth to determine state-specific trends in 2006, 2009, and 2012. The 2003 certificate differs from the previously used 1989 certificate, which recorded cesarean deliveries differently, so the researchers only analyzed data from states that used the 2003 version.

Cesarean delivery has a number of short- and long-term risks and consequences, including surgical complications, neonatal intensive care unit admission, and higher costs, when compared with vaginal delivery.

The American College of Obstetricians and Gynecologists recently released clinical guidelines intended to reduce nonmedically indicated cesarean delivery and labor induction at fewer than 39 completed gestational weeks. States have developed initiatives to reduce cesarean deliveries by improving prenatal care, and hospitals have changed policies to forbid elective delivery before 39 weeks' gestation. Public education strategies have also been implemented.

Approximately 60% of cesarean deliveries are primary cesarean deliveries (those that are being performed for the first time in a woman, regardless of whether she has already had other children).

"After a primary cesarean, a woman has only about a 10% chance of a vaginal birth for subsequent deliveries," the authors write. "Accordingly, efforts to reduce the overall cesarean delivery rate often focus on primary caesareans."

In the 19 states for which data was available in 2006, the primary cesarean delivery rate increased from 21.9% in 2006 to 22.4% in 2009 and then declined to 21.9% in 2012.

In the 28 states and New York City that reported data during 2009 to 2012, the primary cesarean rate declined from 22.1% in 2009 to 21.5% in 2012. Rates declined in 16 of the 29 areas during 2009 to 2012 but remained unchanged in the remaining 13 areas.

When the researchers analyzed data regarding gestational age at delivery, state-specific primary cesarean delivery rates at 38 weeks fell by an average of 10% for 18 of the 29 areas (ranging from 5% in Michigan to 18% in Utah) from 2009 to 2012. The researchers found few state-specific changes at other gestational ages.

For the 38 states, the District of Columbia, and New York City, which were using the 2003 certificate by January 1, 2012, the primary cesarean delivery rate was 21.5%, with state-specific rates ranging from 12.5% in Utah to 26.9% in Florida and Louisiana.

National Vital Stat Rep. Published online January 23, 2014. Full text

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