Low-risk Cesarean Delivery Rates Dropping in US

Troy Brown, RN

November 05, 2014

Low-risk cesarean delivery rates have declined in the United States, going from a high of 28.1% in 2009 to 26.9% in 2013, according to a report published November 5 in the National Vital Statistics Reports.

The low-risk cesarean delivery rate was at its lowest, at 18.4%, in 1997 and rose steadily after that, note Michelle J.K. Osterman, MHS, from the Division of Vital Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, and colleagues.

The authors analyzed data for all low-risk births from 1990 to 2012 to residents living in all states and the District of Columbia. Data for 2013 are preliminary and represent almost 100% of low-risk deliveries in the United States. They defined low-risk cesarean delivery as a cesarean delivery among nulliparous (women giving birth for the first time), term (37 or more completed weeks of gestation), singleton, vertex (head first) births (NTSV).

Approximately 60% of cesarean deliveries are primary, or first-time, cesarean births. After a primary cesarean delivery, there is only about a 10% probability of a later vaginal delivery. One of the US Department of Health and Human Services Healthy People 2010 objectives was to lower the low-risk cesarean delivery rate among women with no prior cesarean deliveries. The Joint Commission's 2009 National Quality Core Measures for hospitals included lowering the cesarean rates among pregnancies as well. "The NTSV rate is used at the hospital level as a quality control measure to reduce the use of elective obstetric procedures before term," the authors write.

Since 2009, low-risk cesarean delivery rates fell for all term gestational ages (at least 37 completed weeks) in more than half of all states. The gestational age that saw the largest decline was 38 weeks, which decreased by 9%.

Rates at all term gestations decreased for all maternal age groups and race and Hispanic origin groups, with the greatest declines in women younger than 40 years (6%) and non-Hispanic white women (6%).

"It is important to note that these definitions of low risk and the definition used in this report...exclude births with some of the more common risk factors for cesarean delivery (i.e., multiple births, breech presentation, prior cesarean delivery, and preterm gestation)," the authors write. However, the authors add, that the term is not intended to imply that low-risk women might not need a cesarean delivery, because some medical risk factors and situations make a cesarean birth the safest for both the low-risk mother and the infant.

"In the latest editions, Healthy People 2020 and The Joint Commission's National Quality Core Measures for hospitals (2014) renewed the objectives to reduce LRC rates, and a recent [American Congress of Obstetricians and Gynecologists] consensus report outlines strategies for preventing the first cesarean delivery," the authors conclude.

National Vital Stat Rep. 2014;63(6). Full text

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