TRENDS IN CESAREAN-SECTION USE IN CALIFORNIA, 1983 TO 1990

OBJECTIVE: Our aim was to assess recent trends in cesarean section use in California. STUDY DESIGN: California discharge abstract data on ho spital deliveries in 1983 through 1990 (379,759 to 587,508 annual deli veries) were used to analyze time trends by indication, age, race, and payment source. RESULTS: California cesarean section rates increased annually from 21.8% in 1983 to 25.0% in 1987 and then decreased to 22. 7% by 1990. Similar patterns were noted for all age and race or ethnic ity groups. Primary cesarean section rates increased from 15.2% in 198 3 to 17.9% in 1987, then decreased to 16.2% by 1990. Declines in repea t cesarean section rates continued throughout 1983 through 1990, accel erating after 1987. For both primary and repeat cesarean section rates , time trends after mid-1987 were significantly different than those f or 1983 to 1987. CONCLUSION: After increasing from 1983 to 1987, Calif ornia cesarean section rates declined from 1988 to 1990. Existing paym ent source differences in cesarean section use increased in magnitude from 1983 to 1990, with privately insured women consistently having th e highest cesarean section rates.