Cesarean delivery: background, trends, and epidemiology

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Public Health

Background:

• Cesarean delivery rates in the United States have reached a historic high of 29.1% in 2004.
• The overall cesarean rate has increased by over 40% since 1996.
• This rise is attributed to increased primary cesarean rates and a decline in vaginal birth after cesarean rates.

Purpose of the Study:

• To analyze cesarean delivery trends in the general population and among women with no indicated risk.
• To review existing literature on cesarean deliveries performed due to maternal request.

Main Methods:

• Analysis of national birth data and hospital discharge records.
• Literature review of studies on cesarean delivery trends and maternal request.

Main Results:

• Primary cesarean delivery rates are increasing, even without clear medical or obstetrical indications (estimated 3-7% of deliveries in nulliparous women).
• Data on maternal request cesareans is limited, and evidence does not strongly support it as the primary driver of the overall cesarean rate increase.
• Vaginal birth after cesarean rates have significantly declined.

Conclusions:

• Systematic data on maternal request cesarean deliveries is lacking.
• Primary cesarean delivery rates are rising across diverse maternal and gestational age groups.
• Further research is crucial to understand factors influencing cesarean decisions, including physician practices, maternal attitudes, and clinical outcomes.