Rates of Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-95

Objectives—This report presents trends in cesarean rates (total and primary) and vaginal birth after previous cesarean (VBAC) rates from birth certificate data for 1991‐95. Trends in rates by age of mother for non-Hispanic white, non-Hispanic black, and Hispanic subgroups are presented. For each subgroup, cesarean and VBAC rates for 1995 are presented by selected demographic and lifestyle characteristics of the mother and by medical risk factors and complications of labor and/or delivery. Methods—Cesarean and VBAC rates were computed based on the information from birth certificates in which the ‘‘method of delivery’’ item was completed. For 1991‐95 all States and the District of Columbia reported information on method of delivery and the item was completed on more than 96 percent of birth certificates. Results—The U.S. cesarean rate dropped 8 percent, from 22.6 in 1991 to 20.8 in 1995. Likewise, the primary cesarean rate dropped 8 percent during this period, to 14.7 per 100 births in 1995 for women with no previous cesarean. During this same period, the VBAC rate increased by 29 percent, from 21.3 in 1991 to 27.5 in 1995. Non-Hispanic white women experienced the greatest decline in the cesarean rate over the period. The cesarean rate for Hispanic women also declined between 1991 and 1995, while the rate for non-Hispanic black women remained relatively steady. Similarly, non-Hispanic white women had the largest increase in the VBAC rate followed by Hispanic women and then non-Hispanic black women. Cesarean rates increased with maternal age for all groups, while VBAC rates declined with increasing maternal age. There was considerable variation in cesarean and VBAC rates by demographic and lifestyle characteristics of the mother as well as by medical risk factors and complications of labor and/or delivery.