Cesarean Birth in the United States: Epidemiology, Trends, and Outcomes

Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 7318, Hyattsville, MD 20782, USA.
Clinics in Perinatology (Impact Factor: 2.44). 07/2008; 35(2):293-307, v. DOI: 10.1016/j.clp.2008.03.007
Source: PubMed


The percentage of United States cesarean births increased from 20.7% in 1996 to 31.1% in 2006. Cesarean rates increased for women of all ages, race/ethnic groups, and gestational ages and in all states. Both primary and repeat cesareans have increased. Increases in primary cesareans in cases of "no indicated risk" have been more rapid than in the overall population and seem the result of changes in obstetric practice rather than changes in the medical risk profile or increases in "maternal request." Several studies note an increased risk for neonatal and maternal mortality for medically elective cesareans compared with vaginal births.

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    • "Caesarean section rates are increasing and spontaneous vaginal birth rates are decreasing nationally and internationally (Laws and Sullivan, 2004; Betran et al., 2007; Hilder et al., 2014). Although caesarean section can be a life-saving operation when performed for certain medical indications (WHO, 2015), spontaneous vaginal birth is a safer birthing outcome for most women and their babies compared to caesarean section (Häger et al., 2004; Macdorman et al., 2008). As midwives we are the caretakers of normal birth and therefore partly responsible for both its decline and the solution to its decline. "
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    ABSTRACT: as concern for increasing rates of caesarean section and interventions in childbirth in Western countries mounts, the utility of the risk approach (inherent in the biomedical model of maternity care) is called into question. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. We hypothesised that there is a relationship between a woman׳s SOC and the childbirth choices she makes in pregnancy. the study aims to investigate the relationship between SOC and women׳s pregnancy and anticipated labour choices. A cross sectional survey was conducted where eligible women completed a questionnaire that provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. 1074 pregnant women completed the study. Compared to women with low SOC, women with high SOC were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with women׳s pregnancy choices. this study relates SOC to physical and emotional health in pregnancy as women with high SOC were less likely to identify pregnancy conditions, had less depressive symptoms and perceived higher levels of support compared to women with low SOC. Interestingly, SOC was not associated with pregnancy choices known to increase normal birth rates. More research is required to explore the relationship between SOC and women׳s birthing outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Midwifery 07/2015; 31(11). DOI:10.1016/j.midw.2015.07.012 · 1.57 Impact Factor
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    • "The flaws in this approach are evident, for example, in the growing controversy over the unintended consequences of routine screening for breast cancer for women (Autier et al., 2011; Roukema, 2013), and in the increasing concern about the longer term (and even epigenetic) potential for adverse effects associated with the continuing rise in the use of caesarean section for an ever wider list of indications in maternity care (MacDorman et al., 2008; Dahlen et al., 2013; Witt et al., 2014). Both seem logical, as a means of preventing adverse events. "
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    ABSTRACT: The linear focus of 'normal science' is unable toadequately take account of the complex interactions that direct health care systems. There is a turn towards complexity theory as a more appropriate framework for understanding system behaviour. However, a comprehensive taxonomy for complexity theory in the context of health care is lacking. This paper aims to build a taxonomy based on the key complexity theory components that have been used in publications on complexity theory and health care, and to explore their explanatory power for health care system behaviour, specifically for maternity care. A search strategy was devised in PubMed and 31 papers were identified as relevant for the taxonomy. The final taxonomy for complexity theory included and defined 11components. The use of waterbirth and the impact of the Term Breech trial showed that each of the components of our taxonomy has utility in helping to understand how these techniques became widely adopted. It is not just the components themselves that characterise a complex system but also the dynamics between them. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Midwifery 06/2015; 31(9). DOI:10.1016/j.midw.2015.05.009 · 1.57 Impact Factor
    • "Países industrializados, como Estados Unidos, Coréia do Sul e Itália têm taxas de cesáreas superiores à 30% (MACDORMAN et al., 2008). "

    01/2015, Degree: Dissertation, Supervisor: Prof. Dr Zilda Pereira da SIlva
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