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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2004.052381v1 96/5/867    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (11) Citing Articles via Google Scholar Google Scholar Articles by Declercq, E. Articles by MacDorman, M. Search for Related Content PubMed PubMed Citation Articles by Declercq, E. Articles by MacDorman, M. Related Collections Other Maternal and Infant Health Other Race/Ethnicity Socioeconomic Factors Women's Health

Eugene Declercq, PhD, Fay Menacker, DrPH and Marian MacDorman, PhD

Eugene Declercq is with the Maternal and Child Health Department, Boston University School of Public Health, Boston, Mass. Fay Menacker and Marian MacDorman are with the Division of Vital Statistics, National Center for Health Statistics, Hyattsville, Md.

Correspondence: Requests for reprints should be sent to Eugene Declercq, PhD, Maternal and Child Health Department, Boston University School of Public Health, 715 Albany St, Boston, MA 02118 (e-mail: declercq{at}bu.edu).

Objectives. We examined factors contributing to shifts in primary cesarean rates in the United States between 1991 and 2002.

Methods. US national birth certificate data were used to assess changes in primary cesarean rates stratified according to maternal age, parity, and race/ethnicity. Trends in the occurrence of medical risk factors or complications of labor or delivery listed on birth certificates and the corresponding primary cesarean rates for such conditions were examined.

Results. More than half (53%) of the recent increase in overall cesarean rates resulted from rising primary cesarean rates. There was a steady decrease in the primary cesarean rate from 1991 to 1996, followed by a rapid increase from 1996 to 2002. In 2002, more than one fourth of first-time mothers delivered their infants via cesarean. Changing primary cesarean rates were not related to general shifts in mothers’ medical risk profiles. However, rates for virtually every condition listed on birth certificates shifted in the same pattern as with the overall rates.

Conclusions. Our results showed that shifts in primary cesarean rates during the study period were not related to shifts in maternal risk profiles.

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