Epidemiology of cesarean delivery: the scope of the problem

Approximately one-third of births in the United States are via cesarean delivery (CD). The rate of CD has increased dramatically since the 1990s, reaching a peak of 32.9% in 2009. The increase can be seen among women of all ages and race/ethnicities, in every state, and across all gestational ages. The primary CD rate has increased from 14.5% in 1996 to 23.4% in 2007. Because the primary CD rate has increased and the rate of trial of labor after CD has decreased, the primary cesarean rate has become a major driver in the total CD rate. Also contributing to the high CD rate is an increase in somewhat subjective indications, such as fetal distress or nonreassuring fetal tracing and failure to progress leading to performance of CD in the latent phase of labor. Addressing these factors--as well as focusing on the use of elective induction and management of early labor in the particular subgroup of nulliparous women at term, with singleton fetuses in vertex presentation--may have a significant impact on the total CD rate.