Effect of decreasing cesarean births on maternal age-, parity- and ethnicity-associated cesarean rates

OBJECTIVE: To evaluate the effect of decreasing cesarean births on the rate s associated with maternal age, parity and ethnicity. STUDY DESIGN: During 1991-1997, 14,689 women delivered at our community hos pital, 2,945 by cesarean (20.0%). The clinical and demographic characterist ics of these women and their newborns were studied. The data were divided a ccording to maternal age, parity and ethnicity. As cesareans began to decre ase in our service during 1994, the data were also divided into two groups: group 1 (1991-1993) and group 2 (1994-1997). chi(2) analysis was used to e valuate the differences between the proportions. A P value < .05 was consid ered significant. RESULTS: Matt mal and perinatal outcomes and some demographic characteristi cs did not change, while cesarean rates decreased. As compared to group 1, cesauealz birth rates decreased in group 2, from 22.5% to 17.9% (P<.0001). The decrease was significant in every maternal age- parity- and ethnicity-r elated subgroup, except for women with parity > 4 (16.7% vs. 16.3%, P = .83 5) and those greater than or equal to 36 years old (31.6% vs. 30.9%, P = .7 98); for them, cesarean birth rate for breech presentation increased in gro up 2 (1.3-4.7%, P = .002). CONCLUSION Cesarean birth rates call be reduced safely, and further studies should determine the factors associated with higher cesarean rates among o lder women.