Changes in cesarean delivery in the United States, 1988 and 1993.

The rate of cesarean delivery in the United States (22.8% in 1993) has remained stable since the mid-1980s after dramatic increases during the 1970s and early 1980s. The primary cesarean rate (16.3 cesareans in 1993 per 100 women with no history of previous cesarean delivery) was also stable from 1988 to 1993. During this same period, the rate of vaginal birth after previous cesarean (VBAC) doubled, from 12.6 to 25.4 percent. In both 1988 and 1993, rates of cesarean delivery were higher in the South than in other regions, for mothers 35 years or older than for younger women, for proprietary than for nonprofit or state and local government hospitals, and for women with private insurance than for women with Medicaid or self-pay as the expected source of payment. Even if VBAC rates continue to increase at the same rate as in the past, the Year 2000 goal of an overall cesarean rate of 15 percent cannot be met without reducing the primary cesarean rate by 50 percent.