title: Unnecessary cesarean delivery in Louisiana: an analysis of birth certificate data.
abstract: OBJECTIVE
  The purpose of this study was to explore the temporal trends and factors that are associated with cesarean deliveries and potentially unnecessary cesarean deliveries.
  
  
  METHODS
  The Louisiana birth certificate database was evaluated to identify a total of 57 potential indications/risk factors and maternal demographic factors that are associated with methods of delivery over the period from January 1993 to December 2000. A cesarean delivery without any potential indications/risk factors in the birth certificate was classified as unnecessary.
  
  
  RESULTS
  The primary cesarean delivery rate decreased and the repeat cesarean delivery rate increased significantly during the study period. But neither the absence nor the presence of potential indications/risk factors accounted for these changes. The average potentially unnecessary primary and repeat cesarean deliveries in Louisiana were 17 and 43, respectively, per 100 cesarean deliveries over the years 1993 through 2000.
  
  
  CONCLUSIONS
  The proportions of potentially unnecessary cesarean deliveries are relatively high in Louisiana. It is important to explore the influence of nonclinical factors on unnecessary cesarean delivery to reduce the cesarean rates.
authors.affiliation: Tulane Center for Clinical Effectiveness and Prevention, Tulane University School of Public Health, New Orleans, LA 70112, USA.
authors.forename: Azad A
authors.initials: AA
authors.lastname: Kabir
authors.forename: William C
authors.initials: WC
authors.lastname: Steinmann
authors.forename: Leann
authors.initials: L
authors.lastname: Myers
authors.forename: M M
authors.initials: MM
authors.lastname: Khan
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Herrera
authors.forename: Shenkang
authors.initials: S
authors.lastname: Yu
authors.forename: Nuruddin
authors.initials: N
authors.lastname: Jooma
mesh_terms: D001719:Birth Certificates; D002585:Cesarean Section / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008145:Louisiana; D008393:Marriage; D008423:Maternal Age; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012307:Risk Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D044465:White People