A new report from the Centers for Disease Control and Prevention tracks trends in rates of cesarean delivery and vaginal births after previous cesarean (VBAC) delivery for 1991-99. The report shows that from 1991 to 1996 the cesarean rate declined while the VBAC rate steadily increased. Since 1996, trends have reversed with cesareans now on the rise and the rate of VBACs declining to early 1990 levels.

The U.S. cesarean rate increased 6 percent between 1996 and 1999 (with preliminary 2000 data showing another 4 percent increase), after declining 8 percent between 1991 and 1996. Women in all racial and ethnic groups experienced the increase, however, the earlier decline was more pronounced among white non-Hispanic women.

The VBAC rate increased 33 percent between 1991 and 1996, then dropped by 17 percent from 1996 to 1999. The dramatic increase in VBAC rates was experienced by women of all ages and for each major race/ethnicity group.

Other highlights of the report show that:
In 1999, there were 862,068 births by cesarean delivery for a rate of 22.0 per 100 births, compared with a rate of 22.6 in 1991.
Cesarean rates are lowest for teenage mothers and increase steadily with maternal age. The 1999 cesarean rate for mothers in their 30s and 40s is approximately double that for teenagers.
In 1999, a total of 97,680 births were delivered by VBAC. VBAC rates were highest for teenagers and lowest for older mothers.
Cesarean rates for all regions and nearly all States increased between 1996 and 1999, but throughout the 1990s, cesarean rates were highest in the South and lowest in the Midwest and West.
Cesarean deliveries were consistently higher for women having their first child than for women having a second or third birth.
Cesarean rates were higher for women with medical risk factors or complications of delivery. However, even for women with risk factors and labor complications, cesarean rates declined during the first half of the decade and then have increased since 1996. Throughout the 1990s, cesareans were more frequently performed for women with diabetes, genital herpes, hypertension, eclampsia, incompetent cervix and uterine bleeding.

The report, "Trends in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-99," is based on birth certificates filed in state vital statistics offices and reported to CDC's National Center for Health Statistics through the National Vital Statistics System. The report examines trends in cesarean and VBAC rates by age, race, ethnicity, and education of mother, medical risk factors, and complications of delivery for the Nation and by State. It provides important information to monitor current patterns and changes in childbirth and delivery in America. The report can be downloaded or viewed without charge from the CDC Website.

Trends in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-99. NVSR Volume 49, No. 13. 15 pp. (PHS) 2002-1120.

© 2001