U.S. Cesarean and VBAC Rates Stalled in the Mid‐1990s

After a significant decline in the cesarean rate in the 34,000 women who were discharged after giving birth United States between 1988 and 1994, the rate has in 1997.reached a plateau at around 21 to 22 per 100 deliveries through 1997.Between 1988 and 1995 the rate of Results vaginal birth after previous cesarean delivery (VBAC) nearly tripled, but has leveled off at around 34 to 35The 1997 total cesarean rate was 21.5 per 100 deliver-(per 100 women with a previous cesarean) between 1995 and 1997.The data on cesarean and VBAC rates ies compared with 21.8 in 1996 and 20.8 in 1995.are from the Centers for Disease Control and Preven-Although the 1997 rate was significantly lower than tion's National Hospital Discharge Survey.the peak rate of 24.7 in 1988, it was not significantly This article presents cesarean and VBAC rates for different from the rates of the three preceding years.1997 for the United States by region of the country, The primary cesarean rate was 15.6 (per 100 women age of the mother, size and type of hospital, and the with no previous cesarean) in 1997, compared with expected source of payment for the delivery.The Na-15.6 in 1996 and 15.5 in 1995.Similar to the total tional Hospital Discharge Survey data are also used rate, the 1997 primary rate was significantly lower to analyze cesareans by indication (breech, dystocia, than the peak rate in 1988 (17.5), but the decline has fetal distress, other, elective repeat) for 1985, 1994, also stalled in the last few years.The 1997 VBAC rate and 1997.was 34.5 (per 100 women with a previous cesarean), which was not significantly different from the rate of Methods 33.6 in 1996 or 35.5 in 1995.The VBAC rate nearly tripled between 1988 (12.6) and 1995.The National Hospital Discharge Survey is based onCesarean and VBAC rates for 1997 by various chara nationally representative sample of inpatients disacteristics available from the National Hospital Discharged from nonfederal, short-stay hospitals.In 1997, charge Survey are shown in Table 1.The total and medical and demographic information was abstracted primary cesarean rates were higher in the South and from the discharge records of a sample of inpatients the Northeast than in either the Midwest or West.This in 474 participating hospitals.The data for this article pattern was also seen in 1996, but previously cesarean are based on the information from a sample of about rates for the Northeast were significantly lower than the rates for the South (1).The total cesarean rate increased markedly with advancing maternal age, and was 74 percent higher for mothers 35 years of age and Sally Curtin is a statistician in the Reproductive Statistics Branch, Division of Vital Statistics; Lola Jean Kozak is a health statistician older (28.7%) than for teenagers (16.5%).The primary in the Hospital Care Statistics Branch, Division of Health Care rate for the mothers 35 years of age and older was Statistics, National Center for Health Statistics, Centers for Disease also significantly higher than for women in all of the Control and Prevention, U.S. Department of Health and Human Services, Hyattsville, Maryland; and Kimberly Gregory is in the younger age groups.