C-Section Rate Rises: 2007 U.S. Cesarean Rate Hit 31.8 Percent
Wednesday, March 18, 2009 at 9:28AM 
The CDC’s National Center for Health Statistics released the findings of its analysis of nearly 99 percent of all birth records reported by 50 states, the District of Columbia, and U.S. territories. Of the record 4,317,119 babies born in 2007, 1,372,844 were delivered via Cesarean section. The c-section rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States according to the CDC.
From the .pdf report, “Births: Preliminary Data for 2007”:
The preliminary cesarean delivery rate rose 2 percent in 2007, to 31.8 percent of all births, marking the 11th consecutive year of increase and another record high for the United States (see table below). This rate has climbed by more than 50 percent over the last decade (20.7 percent in 1996). Increases between 2006 and 2007 in the percentage of births delivered by cesarean were reported for most age groups (data not shown), and for the three largest race and Hispanic origin groups: non-Hispanic white (32.0 percent in 2007), non-Hispanic black (33.8 percent) and Hispanic (30.4 percent). The rise in the total cesarean delivery rate in recent years has been shown to result from higher rates of both first and repeat cesareans (1).
Also interesting is that the number of births in the U.S. in 2007 surpassed the peak of the postwar “baby boom” in 1957.
The preliminary estimate of births in 2007 was 4,317,119, 1 percent more than in 2006 (4,265,555) and the highest number ever registered for the United States. This number surpasses the peak of the postwar ‘‘baby boom,’’ in 1957. Births rose for each race and Hispanic origin group, with increases ranging from less than 1 percent for non Hispanic white women to 6 percent for Asian or Pacific Islander (API) women. Births to non-Hispanic black and Hispanic women each increased by nearly 2 percent.
Other findings:
- The percentage of low birthweight babies declined slightly between 2006 and 2007, from 8.3 percent to 8.2 percent. This is the first decline in the percentage of low birthweight babies since 1984.
- The preterm birth rate (infants delivered at less than 37 weeks of pregnancy) decreased 1 percent in 2007 to 12.7 percent. The decline was seen mostly among infants born late preterm (between 34 and 36 weeks).
The full report is available at www.cdc.gov/nchs.
2007 U.S. Cesarean Rate Posts:
Cesarean Delivery Rates by State, 2007
Map of Cesarean Delivery Rates by State, 2007
C-Section Rate Rises: 2007 U.S. Cesarean Rate Hit 31.8 Percent
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Reader Comments (18)
oh Jesus. I mean, I already knew this.... I see the Expecting Clubs on Ivillage and how so many of those pregnancies end in c-sections. But my god. 11 years of increases? When will this madness end?
I wonder if we'll see a significant change for the 2008 or 2009 births with the release of The Business of Being Born? Only time will tell.
This is incredible. I would really like to see ACOG come out and explain why this solid increase. What has happened that requires this continual rise? How are they justifying this? I'd also like to see this overlaid with a rate of mortality/morbidity.
Just SEEING the actual rise on that graph is alarming. Why is this problem continuously swept under the rug??
Tara-- I will!
Unfortunately, this news is not new to me. I have worked in L&D, and NICU's for 16 years now, and have witnessed this increase first hand. Why is this happening? Well, I would have to say the first reason is defensive medicine. Even though birth via C/S has done nothing in decreasing the morbidity and mortality of infants (it actually increases morbidity), the public and lawyers would disagree. There are also a myriad of other reasons such as: patient request (rare), higher risk mom's, more multiple births, more obesity and gestational diabetes, and a big one is doctor impatience, or intolerance to labor. I am proud to say that I currently work in a hospital that has a lower than the national average in the rate of C/S's. 30% of our deliveries are performed by midwives, and their C/S rate is about 18%. I personally delivered my first baby in an academic teaching hospital. Wanted a natural childbirth, and ended up with a C/S (the nurse curse!). With the second baby, I had a VBAC with the fantastic nurse midwives in the hospital I currently work at. I would love to give testimonials on how much better it is for mom's and babies to delivery vaginally. After all, I am one of the few who experienced birth both ways.
RR, I would love to post your story. If you'd like to write an article or you want me to interview you and write it up, let me know. unnecesarean at gmail.com
Thank you so much for your insightful comment.
I have also experienced both ways of birthing. I can tell you hands down you do not want to take the 'easy way out' via c/s. Mine was not optional or emergency, but rather my placenta was in the way (previa). I am grateful there is modern medicine that is available, because otherwise I would probably not be here. However, if I do have more children, you can bet on it that I will do all that is possible to avoid being sectioned again.
Jenny,
It's weird to hear people call a c-section the easy way out or a way to prevent pain, huh?
Modern medicine rocks when used appropriately. I don't blame you for wanting a VBAC next time around if there is one. I glad you had a healthy c-section birth.
I gave birth to my twins by c-section two weeks ago, and feel way better then I did after having a natural birth.
How wonderful for you! Congratulations on having twins. =)
Great stats! You are using the same stats I am using for my new book! Yes! It is time to re-evaluate the convenience model! Thank you!
The answer for the rising c-section rate is one word lawyers. OB/Gyn docs fear being sued because little Sally had a difficult delivery and as a result did not get accepted to Harvard. The docs fixate on fetal heart rate monitoring, although there is no correlation between FHR monitoring and rate of cerebral palsy.
epidural, usually anonymous commenters with a blocked IP address don't return. You're right about cEFM... the only result of monitoring is more cesareans.
What is your source that lawyers are to blame? Also, do you know of any cases in which OBs have been found responsible for the condition of a 17 or 18 year old? That story has worked its way into our culture's mythology, so I wonder what you're referring to.
There are some ubersleazy birth injury sites runs by lawyers, but do you really think they're to blame?
Jill,
I agree that the sources suggesting that lawyers are to blame are sketchy. I've been researching this and there's no expected connection between number of obstetric malpractice suits, awards in those suits, or malpractice liability premiums and cesarean rates. Evidence for tort reforms is mixed and there's a recent study in the Quarterly Journal of Economics (Currie and MacLeod) that finds that discretionary c-sections are more common when doctors are less accountable for malpractice (when there are caps on non-economic damages) and less common when they are more accountable for the quality of care they provide. I'll be investigating this further with lots of statistics! But what I've seen so far confirms Marsden Wagner's conclusion that malpractice is just an excuse, and is not the prime mover in this trend.
Hm, the lawyer connection sounds plausible but doesn't seem to be borne out by statistics. The rate in Canada where malpractice judgements are *much* smaller is 28% whereas it's 31% in the US. That's probably a significant effect but it's pretty small.
On the other hand the rate for insured women is 34% whereas it's 25% for uninsured -- that's a much bigger difference. It seems more likely it's a function of large-scale demographic shifts. Are a larger percentage of women covered by insurance or better insurance? Or are a larger percentage in urban areas where they're treated in hospitals than rural centres?
I wonder about Gerg's questions too. One of the other issues I see is the tendency of hospitals/care providers to assume a position of authority where submitting to medical procedures is expected. So many interventions are here to "assist us" in certain settings, that avoiding them becomes a battle of wills. But I believe that many providers/nurses really think they are helping when they "insist" women do it their way.
I think too of the docs who DO complete the ACOG survey- the experience they have seeing and treating women with unsuccessful homebirth attempts is what they think homebirth IS. They are not there to witness all the successful and peaceful and healing births that happen at home safely.
Maybe a question we can ask is: how we can help open the minds of the doctors who assist women with needed hospital transfers, to be less judgmental and more accepting of homebirth as a safe option. If there was a receptive doctor on the other end of the transfer, it would be easier to have peace of mind if I needed to go to a hospital during labor.
It's a shame it's not required for doctors to witness homebirth as part of their study- to see what birth could really be like. I talked to a doc who really didn't get why home is different than a really home-y hospital room. For me it's about that "assistance" that I don't want to have to worry about.
Karen, I don't know very many homebirthing moms who would let a doctor anywhere near them when they're birthing--to observe or otherwise! I know I certainly wouldn't; I'm birthing at home, at least in part, because I'm trying to avoid doctors--they screwed me over the first time! Huh-uh. No. Way.
My two cents...
As a medical biller, I know for a fact that doctors get paid more money for cesarean births than vaginal births. Lets not forget that childbirth has become an viable, capitalistic industry and doctors who operate their own facilities are just as much business men and women as they are doctors.
Having stated this, we have been raised from little girls to grown women to trust doctors as they "know" more about our bodies as we do, and in this culture we have disconnected from our bodies. I cannot help but wonder if more women are in tune to the inner workings of the female body and their own, if there would be a decrease in cesarean rates.
Allow me to expound... my motto in life is about balance, while I believe in the natural ability in my body to conceive, gestate and birth, Im also striving to be "open-minded" to REASONABLE, necessary procedures. With this mind frame, I have studied "Taking Charge of Your Fertility' by Toni Weschler a few years ago and have spaced my children this way. What I have gained in knowledge, has been nothing short of empowering... a blessing that has protected me and my children from harm. From this knowledge, I could tell when I conceived and when I was going to be pregnant. I was also able to pinpoint my due date to the week. And I did just that while expecting my fourth baby.
My midwife had a different due date for me (July 20 something), however she sent me to a doctor's office ( I was doing a home birth) for an ultrasound, at that point I was seven months along. During the appointment the doctor announced that we were having a boy, he also announced that my due date was wrong. Instead of my August 15th due date, He said my due date was July 20 th. I explained to the doctor that I chart my cycle and I knew when I conceived , he basically ignored this information and insisted "according to his calculations and the baby's weight, I was at term". Needless to say my husband and I were shocked and confused. I went over my charting again, and figured maybe I was wrong, and even arrogant to assume I know any thing about due dates.
Long story short, July 20th came and went. By the first week of August, I KNEW my due date of August 15th was correct and I felt horrible for doubting what I knew. My beautiful and BIG baby boy was born August 20th, exactly one month from the doctor's "calculated" due date. What was so scary to me was, if I wasn't empowered in knowledge the way I was, undoubtedly I would have been induced for being past term, OR sectioned for having a "big" baby. I just cannot help but wonder how many doctors with their "calculated" dated have caused more harm than good.