Trends in cesarean rates for first births and repeat cesarean rates for low-risk women: United States, 1990-2003.

OBJECTIVES This report presents trends in cesarean rates for first births and repeat cesarean rates for low-risk women, in relation to the Healthy People 2010 (HP 2010) objectives. Data for the U.S. showing trends by maternal age and race and Hispanic origin are presented. METHODS Cesarean rates were computed based on the information reported on birth certificates. RESULTS With a decrease between 1990 and 1996 and an increase between 1996 and 2003, the trend in the cesarean rate for low-risk women having a first birth paralleled trends in the primary (regardless of parity) and total cesarean rates. During 1996-2003 the cesarean rate for low-risk women having a first birth has consistently been at least 13 percent lower than the rate for all women having a first birth. For 2003 the cesarean rate for all primiparous women was 27.1 percent; for low-risk women the rate was 23.6 percent. The trend in the repeat cesarean rate for low-risk women was similar to the trend in the repeat rate for all women, i.e., a decrease from 1990 to 1996 and an increase from 1996 to 2003. The repeat cesarean rate for low-risk women has consistently been slightly lower than the rate for all women. For 2003 the repeat rate for all women was 89.4; the rate for low-risk women was 88.7. These trends were found for low-risk women of all ages and racial or ethnic groups. Therefore, low-risk women giving birth for the first time who have a cesarean delivery are more likely to have a subsequent cesarean delivery.