Although the rate for low-risk cesarean deliveries increased 60% between 1997 and 2009, the procedure might be declining according to a Nov. 5 Centers for Disease Control and Prevention report.
The report, which defines low risk cesarean deliveries as those occurring among term, singleton, vertex or head-first births to first-time moms, examines trends in low-risk cesarean delivery rates from 1990 to 2013.
Researchers found the low-risk cesarean or LRC rate rose from a low of 18.4% in 1997 to a high of 28.1% in 2009. But the LRC rate decreased from 2009 to 2013, reaching 26.9%, with numbers being down for more than one-half of states. Rates also decreased among all maternal age groups and race and Hispanic origin groups, the report said. Women under 40 saw the largest decline at 6% to 8%, with non-Hispanic white women also seeing a decrease at 6%. The largest and most consistent declines in LRC delivery were among women whose pregnancies were at 38 weeks gestation, the report said.
Although data for 1990 to 2012 that was based on 100% of all birth certificates filed in the U.S., data for 2013 remains preliminary and is based on 99.8% of births for that year, the report said. When it came to data by individual states, the report showed LRC rates have decreased for 30 states since 2009, with rates in Hawaii, Massachusetts and Virginia declining 15% or more during that time period. Researchers noted efforts made in recent years to reduce the number of non-medically indicated cesareans and labor inductions, particularly with deliveries under 39 completed weeks of gestation.
The report credits the declining LRC rate to new guidelines from the American Congress of Obstetricians and Gynecologists, initiatives to improve prenatal care, changes in hospital policies to not allow elective delivery before 39 weeks and public education campaigns. Still, nearly one-third of births continue to be delivered by C-section annually, according to the report.
This report and other recent reports that document changes in total and primary cesarean delivery, induction of labor, and in the gestational age distribution of births suggest a recent shift in labor and delivery management among singleton births in the United States, the researchers wrote. There have been substantial reductions in cesarean delivery and labor induction before 39 weeks (particularly at 38 weeks), as well as declines in rates of labor induction and primary cesareans (including low-risk cesareans) for births after 39 weeks, which may be associated with the shift toward longer pregnancies.
To read the full report, visit http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_06.pdf.