Thursday
Mar182010
United States Cesarean Rates by Year, 1970 to 2007
Thursday, March 18, 2010 at 11:57AM
In anticipation of the CDC releasing its 2008 preliminary birth data, including the 2008 cesarean rate, here is a chart of the cesarean rate from 1970 to 2007.
Please click here to enlarge image.
Will be updated when 2008 data becomes available. Certain years (1971-74, 1976-79, 1981-82 not shown).
Reader Comments (21)
Interesting. Would love to see maternal and infant mortality superimposed on that...
Also, I was born in 1972. I was stuck in the birth canal b/c my mom's "tailbone" curved in. Kept hitting it and bouncing back up. Today they would have done a c-section. Back then they just broke her tailbone (yikes!). Of course, if she had not been on her back and had had a midwife, there were plenty of ways to remedy the situation with positioning. But personally, I'd take a broken tailbone over a c-section any day...
Ditto Lulu, I'd love to see this data w/ mortality rates. Thanks for posting, very interesting and sobering.
Yes! Y'all read my mind. Let's cross-reference this with outcomes. Has *really* saved lives and improved things. I think not.
Funny, we all thought the exact same thing.
Dittoes to comments above!
Well, we do know that the maternal mortality rate is rising. Back in 1982, the maternal mortality rate in the United States was 7.5 per 100,000, in 1990 it was 8.2 per 100,000, in 2003 it was 12.1 per 100,000, and in 2005 it was 15.1 per 100,000.
Compare those numbers to that graph, and it seems to go along with it. Not only are the number of cesarean sections now higher than ever, induction of labor has more than doubled since 1990.
I think it would be interesting to see the maternal mortality rates mapped on there as well, but I would interpret them cautiously - I wrote a post about this recently: http://phdoula.blogspot.com/2010/03/is-maternal-mortality-in-us-on-rise-or.html
Basically, we have been doing a much better job of reporting maternal deaths over the past several decades (in part because of birth activists pushing for better tracking!) and that makes the trends a little more tricky to interpret: there is a not insubstantial percentage of maternal mortality difference between say, now and 1980 that is simply because a lot of deaths are getting counted now that weren't then.
Very interesting. I was surprised to see the greatest percentage increase was from 1970 to 1980 (>10%)increase), then from 2000 to 2007 (>9% increase). C/S rates seemed relatively stagnant in other decades. Can any medical historians out there think of reasons for this? There seems to be a lot of confounding factors: litigation, higher risk patients, rise of reproductive technology in the 70's, multiple births, insurance policies, hospital policies, etc.
Seeing maternal and infant mortalities superimposed would be interesting, but not necessarily informative. Like Rebecca stated, reporting mechanisms are not what they used to be in the 1970's. Very, very interesting.
I think it would be interesting, too, but I'm not sure what you could definitively infer from it. You all are going to kill me but I had thought about juxtaposing it with something random like Per Capita Annual Banana Consumption or Star Wars Action Figure Sales before I posted it. I am weird and it was really funny in my head.
@RR -- I'm not a medical historian, but the general explanation for the big jump in C-sections from the 70s onwards is that they were made so much safer they were no longer a "last resort" option. Also, they started using EFM in the 80s which (according to several studies and even ACOG itself) has not lowered perinatal mortality but has increased the rate of C-sections.
However, there are a lot of reasons for maternal mortality, so I doubt that there would be a strict correlation between C-sections and the MMR as a whole. Many states may not even code a maternal death properly, although several states have changed their death certificate paperwork to make it more likely for maternal deaths to be coded. So, better recording may lead to better statistics and an apparently higher MMR when the real rate was high all along, but we just didn't know it. I read somewhere that the CDC figures it undercounts maternal mortality by at least 30%, and I think other sources may put it even higher.
Regardless if the rise in maternal mortality is superficial, and really is due to better reporting of death, this graph still shows the c/s rates are rising. So many women undergoing major abdominal surgery, and we don't really know the long term consequences of this being done on so many women, so often. I wonder if we will start hearing more stores like the one you posted a while back Jill, about the woman who wrote you about her mother who had a complication from her cesarean YEARS out.
Dr. A just posted about Amnesty International's statement about rising maternal mortality. She stated the c/s rate most likely has nothing to do with the rise in maternal mortality, or at least not as much as birth advocates make it seem. She posted various graphs and broke down the numbers, explaining that the overhaul of reporting maternal deaths is the cause of, or at least a major contributor to, the 'rising' maternal mortality rate. I have to say, it did make me see how that did contribute in some way.
But, there was one graph she posted that showed specific complications from which women died: indirect, other direct, eclampsia, hemorrhage, and embolism. The last three (eclampsia, hemorrhage, and embolism) remained pretty stable throughout the years, but the other two, direct and other direct, are rising, quite steadily.
When I asked her what indirect and other direct referred to, she said Indirect causes would include pre-existing medical conditions, like heart disease. Other direct complications would include things like infection, surgical complications and anesthesia complications.
Heres' the graph:
http://4.bp.blogspot.com/_TBIyP9vftYk/S6KZOlPR8VI/AAAAAAAAAQc/Y5eEhlqc4LA/s1600-h/maternal+mortality+specific+causes+1998-2006.gif
Other Direct is the highest... and she said it includes things like infection, anesthesia complications, surgical complications, Does anyone else see what I am getting at? Even if these are not all caused by cesarean sections, they are caused by obstetric interventions, (except infection, unless it is referring solely to infection after a surgical procedure).
I found it very interesting. I would really love to see those specific numbers from Other direct broken down.
It's interesting how much the Cesarean rate skyrocketed in the 1970s and 1980s. You can also see the downtick when VBACs were recommended in the late 80s and early 90s and the uptick again after the NEJM article questioning the safety of VBACs (the one negative scientific study amongst a gazillion positive ones).
Regarding maternal mortality:
"...not as much as birth advocates make it seem." That sounds like Dr. Amy;)
I find it interesting that direct causes are up 6-fold in only 8 years per the linked table from michele.
This WHO document is also interesting. It compares US maternal mortality with that of other countries. Lifetime risk of maternal mortality in the USA was 1 in 4800 in 2005. It's kind of shocking to see risks of 1 in 47600 in Ireland and 1 in 29000 in Bosnia. Of course, reporting could be quite different, but it still rightly makes us question our prenatal care and obstetrical management and how to improve in those areas. It can't just be that we are all obese in the USA ;)
http://www.who.int/reproductivehealth/publications/monitoring/9789241596213/en/index.html
Lulu,
Good God. I hope you never smarted off to your mother!
;)
Jill,
"Per capita banana consumption", "Star Wars Action Figure Sales"?
You are hysterical. I would have laughed for days with that overlay!
My brothers and I were born in 1972, 1974 and 1981. My mom went 9-10 days "overdue" and had such long labors with very slow progress that I believe she would have been induced and/or sectioned for failure to progress these days. Scary thought, since we were all healthy and so was she.
KK, my brother and I would have been born by c-section. No doubt. My mom's OB was concerned about her being weeks past her due date, being petite with what must have been a huge fundal measurement and gave her an x-ray to measure her pelvis. Yes, I was x-rayed as a fetus. Lucky me. My point is that the push was to reassure her (and him) that she could give birth vaginally, not to try to build a case for a c-section. It's a totally different mindset.
my sister and i would also have beenborn by c-section today. We were 9 weeks premature twins. At the hospital tour that we took before our daughter was born we were told that their high c-section rate was due to babies being born before 35 weeks because "their little bodies couldn't take being born vaginally". Seriously? My sister and I were born at 31weeks and our bodies were just fine, thanks! That was in 1982, though, when c-section rates were pretty low.
Wait...is the CDC really, truly going to release the 2008 rates in the really, truly near future? (I'm still stunned by the insinuation that this is FINALLY around the corner!)
I'd like to see the birth injury rates over the same period so we can tell whether all these surgeries that are supposed to prevent bad outcomes for babies might have any correlation.
LOL on the bananas, Jill.
Birth injuries/ neonatal mortality is an interesting idea. I think what I'll do is throw some of these together with a big disclaimer that this is just a crude visual presentation, not anything scientific.
I'd like to know at what point spinal anesthesia came into the picture because that's when the risks to the baby would have dropped considerably.