Recent trends in cesarean section use in California

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Services Research

Background:

• Cesarean section is the most common hospital surgical procedure in the US, with rates reaching 24.7% by 1988.
• Examining cesarean section trends in California provides insights into obstetric practices and future patterns.
• Understanding these trends is crucial for public health initiatives and resource allocation.

Purpose of the Study:

• To analyze recent trends in cesarean section use in California hospitals.
• To identify key indications contributing to cesarean section rate changes.
• To project future cesarean section rates based on observed trends.

Main Methods:

• Analysis of California hospital discharge abstracts from 1983 to 1987.
• Application of least-squares regression models to evaluate time trends.
• Examination of overall and indication-specific cesarean section rates.

Main Results:

• Total cesarean section rates in California increased from nearly 22% in 1983 to 25% in 1987 (a 15% rise).
• Increased rates of previous cesarean sections and fetal distress were primary drivers.
• Rising rates for breech presentation and dystocia were observed, partially offset by declining repeat cesarean rates.
• No significant change in trends was detected after mid-1985, suggesting limited impact of recent policy interventions.

Conclusions:

• Cesarean section rates in California showed a significant upward trend from 1983-1987.
• Specific indications like previous cesarean birth and fetal distress are key contributors to this rise.
• Future projections indicate a continued increase, reaching 34% by the year 2000, necessitating further investigation into contributing factors and potential interventions.