Primary cesarean deliveries prior to labor in the United States, 1979-2004.
OBJECTIVE
To provide for the United States yearly estimates of first-time (primary) cesareans prior to labor and to examine factors associated with 1979-2004 trends.


METHODS
We estimated the annual percent of total, primary, and repeat cesareans with and without labor for 15- to 44-year-old women with live births in the 1979-2004 National Hospital Discharge Survey (NHDS; N=706,062). For women without prior cesareans (N=628,064), we used logistic regression to examine whether trends in primary cesarean before labor are explained by changes over time in: (1) the frequency of pregnancy complications, women's age, principal source of payment for delivery, hospital ownership, size, and region; and (2) the decision to deliver by cesarean when complications are present.


RESULTS
Annually 4.5-6.6% of women delivered by primary cesarean prior to labor in 1979-2004. Recently, there has been a rise. An increase in reported pregnancy complications contributed to more primary cesareans before labor in 1979-2004. Changes in women's age, principal payment source, and hospital characteristics do not explain 1979-2004 trends. Changes in delivery practices with respect to seven complications increased primary cesareans before labor in the 1980s.


CONCLUSIONS
From 1979 to 2004, primary cesareans before labor contributed less to total cesareans than primary cesareans during labor and repeat cesareans without labor. Since 1998, primary cesareans pre-labor have increased less than previously reported. The recent increase is not explained by changes in the frequency of pregnancy complications, women's age, insurance, or delivery hospital characteristics. Changes in delivery practices regarding pregnancy complications may have contributed to the recent increase.
Joesch
Jutta M
JM
Battelle Centers for Public Health Research and Evaluation, 1100 Dexter Avenue N, Suite 400, Seattle, WA 98109-3598, USA. joesch@battelle.org
Gossman
Ginger L
GL
Tanfer
Koray
K
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003625:Data Collection; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013995:Time; D014481:United States