Rising cesarean rates: are patients sicker?
OBJECTIVE
Our study explored if patient risk factors for cesarean delivery (CD) are changing over time.


METHODS
North Carolina birth certificates from 1995 were used to build a logistic regression model to predict the probability of primary CD. The model estimated each patient's probability of primary CD for 4 years of deliveries (397,793). The percentage of the population in each of the 10 CD risk deciles were compared across years.


RESULTS
The incidence of primary CD rose from 16.6 to 18.4 (P<.0001). Despite this increase over time, more women were low risk (probability of CD <10%) (43.2% to 46.4%, P<.0001). The cesarean rate even rose for women in the lowest risk group (4.6% to 5.9%, P<.0001).


CONCLUSIONS
The rate of primary CD is increasing, despite improvements in patient risk profile. The increasing CD rate may result from changes in physician behavior, institutional factors, and increasing patient demand for elective cesarean delivery.
Division of Maternal-Fetal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
Jennifer L
JL
Bailit
Thomas E
TE
Love
Brian
B
Mercer
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D016015:Logistic Models; D017060:Patient Satisfaction; D010819:Physician's Role; D011247:Pregnancy; D012307:Risk Factors