Declining trends in cesarean deliveries, Ohio 1989-1996: An analysis by indications

Background: Similar to trends observed nationwide, the rates of cesarean de liveries declined in Ohio during the late 1980s and the early? 1990s. This strictly examined the trends in cesarean deliveries in Ohio from? 1989 thro ugh 1996, in the presence or absence of indications, and in relation to the use of obstetric procedures. Methods: Birth certificate data for all singl eton, liveborn infants in Ohio (n = 1,204,859) were used to analyze tempora l trends in cesarean sections. Results: The rates of primary and repeat ces arean deliveries declined, respectively, from 15.7 to 12.4 percent and fron t 83 to 63.3 percent during the 8-year study period. Significant declines i n repeat cesarean deliveries were observed both in the presence and absence of documented medical conditions that could present a potential indication far the procedure. The rates of repeat cesareans remained comparable among women with and without documented indications for cesarean section (64% an d 61%, respectively). In addition, 45 and 30 percent of repeat cesareans in 1989 and 1996, respectively were performed in the absence of any documente d indications, or on an elective basis. The declines in cesarean delivery r ates during the 8-year study period occurred simultaneously with an increas e in the use of electronic fetal monitoring, induction, and stimulation of labor: Conclusions: The findings suggest that a sizable proportion of repea t cesarean deliveries in 1996 may be unnecessary, even thought a marked dec line in the procedure has occurred between 1989 and 1996.