Rise in “no indicated risk” primary caesareans in the United States, 1991-2001: cross sectional analysis
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38279.705336.0B (Published 06 January 2005) Cite this as: BMJ 2005;330:71
- Eugene Declercq, professor, maternal and child health (declercq@bu.edu)⇑1,
- Fay Menacker, statistician2,
- Marian MacDorman, statistician2
- 1 Maternal and Child Health Department, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118-2526, USA
- 2 Division of Vital Statistics, National Center for Health Statistics, Hyattsville, MD 20782, USA
- Correspondence to: E Declercq
- Accepted 7 September 2004
Introduction
This paper analyses US national birth certificate data on approximately 4 million births annually to create a new category—mothers at “no indicated risk”—and then examines the growth of primary caesareans in these women from 1991 to 2001. No indicated risk denotes mothers with singleton, full term (≥ 37 weeks), vertex presentation births who were not reported to have any medical risk factors and for whom no complications of labour or delivery were listed on the birth certificate. (See bmj.com for definitions.)
Methods and results
The proportion of mothers at no indicated risk decreased from 46% of all births in 1991 to 42% in 1998 but has since levelled off (table). However, the primary caesarean rate for this exceptionally low risk group rose 67% between 1991 (3.3%) and 2001 (5.5%), with a gradual increase from 1991 to 1996 and a rapid one thereafter.
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Percentage of all live births to women with no indicated risk factors* and associated rate of primary caesarean delivery, …