Clapp, M. A., & Barth, W. H. (2017). The Future of Cesarean Delivery Rates in the United States. Clinical obstetrics and gynecology, 60(4), 829-839. https://doi.org/10.1097/GRF.0000000000000325
Clapp MA, Barth WH. The Future of Cesarean Delivery Rates in the United States. Clin Obstet Gynecol. 2017;60(4):829-839. doi:10.1097/GRF.0000000000000325
Clapp, Mark A., and William H. Barth. "The Future of Cesarean Delivery Rates in the United States." Clinical obstetrics and gynecology, vol. 60, no. 4, 2017, pp. 829-839.
For EndNote, Zotero or Mendeley:
License
No open license is recorded for this paper. Reuse terms are set by the publisher.
The US cesarean delivery rate remains 30%-32%. Increases in maternal age, obesity, and diabetes put upward pressure on this rate. Alternatives to cesarean delivery, vaginal birth after cesarean (VBAC), and operative vaginal delivery, are underutilized and there are substantial challenges to their resurgence. Practice guidelines offer promise, but demonstrate only minor reductions in cesarean delivery. We estimate that the overall rate in the US will remain 27%-30% for the immediate future. As more states move to recognize the independent practice of midwifery and more payers seek lower cost options for childbirth, we anticipate the overall rate will drop to 20% or 25%, but not for another 15 years or more.
Pineles BL et al., 2023·AJOG Glob Rep·Free full text on PubMed Central
Cesarean delivery is a major source of maternal morbidity, and repeat cesarean delivery accounts for 40% of cesarean delivery, but recent data on the trial of labor after cesarean and vaginal birth after cesarean are limited. This study aimed to report the national rates of trial of labor after cesarean and vaginal birth after cesarean by number of previous cesarean deliveries and examine the effect of demographic and clinical characteristics on these rates. This was a population-based cohort study using the US natality data files. The study sample was restricted to 4,135,247 nonanomalous singleton, cephalic deliveries between 37 and 42 weeks of gestation, with a history of previous cesarean delivery and delivered in a hospital between 2010 and 2019. Deliveries were grouped by number of previous cesarean deliveries (1, 2, or ≥3). The trial of labor after cesarean (deliveries with labor among deliveries with previous cesarean delivery) and vaginal birth after cesarean (vaginal deliveries among trial of labor after cesarean) rates were computed for each year. The rates were further subgrouped by history of previous vaginal delivery. Year of delivery, number of previous cesarean deliveries, history of previous cesarean delivery, age, race and ethnicity, maternal education, obesity, diabetes mellitus, hypertension, inadequate prenatal care, Medicaid payer, and gestational age were examined concerning the trial of labor after cesarean and vaginal birth after cesarean using multiple logistic regression. SAS software (version 9.4) was used for all analyses. The trial of labor after cesarean rates increased from 14.4% in 2010 to 19.6% in 2019 (P<.001). This trend was seen in all categories of number of previous cesarean deliveries. Moreover, vaginal birth after cesarean rates increased from 68.5% in 2010 to 74.3% in 2019. The trial of labor after cesarean and vaginal birth after cesarean rates were the highest for deliveries with a history of both 1 previous cesarean delivery and a vaginal delivery (28.9% and 79.7%, respectively) and the lowest for those with a history of ≥3 previous cesarean deliveries and no history of vaginal delivery (4.5% and 46.9%, respectively). Factors associated with the trial of labor after cesarean and vaginal birth after cesarean rates are similar, but several factors have different directions of effect, such as non-White race and ethnicity, which is associated with a higher likelihood of trial of labor after cesarean but a lower likelihood of successful vaginal birth after cesarean. More than 80% of patients with a history of previous cesarean delivery deliver by repeat scheduled cesarean delivery. With vaginal birth after cesarean rates increasing among those who attempt a trial of labor after cesarean, emphasis should be put on safely increasing the trial of labor after cesarean rates.
Osterman MJK et al., 2026·National Vital Statistics Reports·Free full text on PubMed Central
This report presents 2024 data on U.S. births by selected characteristics. Trends in fertility patterns and maternal and infant characteristics are described. Descriptive tabulations based on birth certificates of the 3.63 million births registered in 2024 are shown for various maternal demographic and health characteristics; medical and healthcare utilization, including source of payment for the delivery; and infant health characteristics. Selected data by mother's state of residence and birth rates also are shown. Trends for 2010 to 2024 are presented for selected items and by race and Hispanic origin for 2016-2024. A total of 3,628,934 births occurred in the United States in 2024, an increase of 1% from the record low reported for 2023. The general fertility rate declined 1% from 2023 to 53.8 births per 1,000 females ages 15-44 in 2024. Birth rates declined for females ages 15-34 from 2023 to 2024, rose for women ages 40-44, and were unchanged for females ages 10-14 and women ages 35-39 and 45-49. The total fertility rate declined 1% to 1,599.5 births per 1,000 women in 2024, a record low. Birth rates declined for both unmarried and married women from 2023 to 2024. Prenatal care beginning in the first trimester declined to 75.5% in 2024. The percentage of women who smoked during pregnancy declined to 2.4%. The cesarean delivery rate increased by less than 1% to 32.4%. Private insurance as the source of payment for the delivery increased to 51.8% of births, while Medicaid deliveries declined to 40.2%. The preterm birth rate (10.41%) was unchanged from 2023; low birthweight births declined 1% (8.52%). The twin birth rate declined 2% in 2024 to 30.1 per 1,000 births; the triplet and higher-order multiple birth rate was 71.3 per 100,000 births compared with 73.8 for 2023.
Birth and Delivery › Cesarean Birth › Cesarean Indications and Rates · Ethics and Policy › Policy and Regulation › Professional Standards
Mark A Clapp, William H Barth
M Clapp, Bill Barth, Will Barth, Billy Barth, W Barth
PMID 29045299 29045299 DOI 10.1097/GRF.0000000000000325 10.1097/GRF.0000000000000325 Clapp et al. 2017, Clapp 2017
Cite this article
Clapp, M. A., & Barth, W. H. (2017). The Future of Cesarean Delivery Rates in the United States. Clinical obstetrics and gynecology, 60(4), 829-839. https://doi.org/10.1097/GRF.0000000000000325
Clapp MA, Barth WH. The Future of Cesarean Delivery Rates in the United States. Clin Obstet Gynecol. 2017;60(4):829-839. doi:10.1097/GRF.0000000000000325
Clapp, Mark A., and William H. Barth. "The Future of Cesarean Delivery Rates in the United States." Clinical obstetrics and gynecology, vol. 60, no. 4, 2017, pp. 829-839.
