Important Facts for Cesarean delivery among low risk women with no prior births
Definition
A cesarean delivery is a surgical procedure in which a fetus is delivered through an incision in the mother's abdomen and uterus.Numerator
Number of cesarean deliveries among low risk women (with full term, single, head down baby) with no prior birthsDenominator
Number of live births to low risk women (with full term, single, head down baby) with no prior birthsData Interpretation Issues
"Low risk" refers to women giving birth whose baby is full term (37 weeks or greater), singleton (not a twin or other multiple-fetus pregnancy), and in the vertex or head down position. By framing the data in this way, eliminating higher risk pregnancies that are more likely to require a cesarean delivery, we can more accurately reflect increases in cesarean rates for women who have the least medical likelihood of needing a surgical delivery.Why Is This Important?
The World Health Organization (WHO) defines normal birth as "...spontaneous in onset, low risk at the start of labor and remaining so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth, mother and infant are in good condition." The aim of the care in normal birth is "to achieve a healthy mother and child with the least possible level of intervention that is compatible with safety. In normal birth, there should be a valid reason to interfere with the natural process." In 1970, the United States had a cesarean delivery rate of 5%. This increased to 20.8% in 1997, and to 32.1% in 2021, when nearly one-third of all children in the U.S. were born by cesarean delivery. The increases are present in all age groups and for all races and ethnic origins, without identified concurrent sources of increased obstetrical risk. A controversial aspect of this discussion is cesarean delivery on maternal request (CDMR) at term for a singleton pregnancy in the absence of any medical or obstetrical indication. It is not possible to obtain a confident estimate of the rate of CDMR at this time. Since a cesarean delivery entails major surgery for the mother, the following complications may occur (and may occur at a greater rate than for vaginal delivery): postpartum hemorrhage, infection, operative injury, thromboembolism, hysterectomy, anesthetic complications, placental problems in subsequent pregnancies (including placenta previa and accreta), postpartum depression, and increased risk of surgical complications in the presence of maternal obesity. Effects of cesarean delivery on the newborn may include difficulty with the initiation of breastfeeding, prematurity and its sequelae, lacerations, and respiratory problems. Both mother and infant will experience longer and more costly hospital stays than after a normal vaginal delivery.Healthy People Objective MICH-7.1:
Reduce cesarean births among low-risk women with no prior cesarean birthsU.S. Target: 23.9 percent
State Target: 16.7 percent