NCHS Data Brief ■ No. 35 ■ March 2010

u.s. department of health and human services

Centers for Disease Control and Prevention

National Center for Health Statistics

Recent Trends in Cesarean Delivery in the United States

Fay Menacker, Dr. P.H., and Brady E. Hamilton, Ph.D.

Key findings

Data from the Natality Data 

File, National Vital Statistics 

System

•	 The cesarean rate rose 

by 53% from 1996 to 2007, 

reaching 32%, the highest rate 

ever reported in the United 

States. 

•	 From 1996 to 2007, the 

cesarean rate increased for 

mothers in all age and racial 

and Hispanic origin groups. 

The pace of the increase 

accelerated from 2000 to 

2007. 

•	 Cesarean rates also 

increased for infants at all 

gestational ages; from 1996 to 

2006 preterm infants had the 

highest rates. 

•	 Cesarean rates increased 

for births to mothers in all 

U.S. states, and by more than 

70% in six states from 1996 to 

2007. 

In 2007, nearly one-third (32%) of all births were cesarean deliveries (1). 

Although there are often clear clinical indications for a cesarean delivery, the 

short- and long-term benefits and risks for both mother and infant have been

the subject of intense debate for over 25 years (2). Cesarean delivery involves 

major abdominal surgery, and is associated with higher rates of surgical 

complications and maternal rehospitalization, as well as with complications 

requiring neonatal intensive care unit admission (3–5). In addition to health 

and safety risks for mothers and newborns, hospital charges for a cesarean

delivery are almost double those for a vaginal delivery, imposing significant

costs (6).

This report shows trends in cesarean delivery since 1991, focusing on the 

period from 1996 to 2007 when cesarean rates began to rise following a 

decline in the early 1990s. Data for 2007 are preliminary and 2006 data are 

presented when preliminary 2007 data are not available (1,7). 

Keywords: cesarean delivery • race and Hispanic origin • gestational age • 

state specific rates 

In 2007, the cesarean rate was the highest ever reported in 

the United States.

)LJXUH&HVDUHDQGHOLYHU\UDWHV8QLWHG6WDWHV±

6285&(&'&1&+61DWLRQDO9LWDO6WDWLVWLFV6\VWHP

        











  







3HUELUWKV





       

<HDU
NCHS Data Brief ■ No. 35 ■ March 2010

■  2  ■

There were 1.4 million cesarean births in 2007, representing approximately one-third of all births 

in the United States. 

Following a decline in the early 1990s, the cesarean rate increased by 53% from 1996 to 2007, 

from 21% to an all-time high of 32% (Figure 1). 

The number of cesarean births increased by 71% from 1996 (797,119) to 2007 (1,367,049). 

Cesarean rates rose for women in all age groups in the last decade.

Cesarean rates rose for women in all age groups from 1996 to 2007 (Figure 2). Rates for all age 

groups increased modestly from 1996 to 2000, then rose more than 33% from 2000 to 2007. 

Women under age 25 experienced the greatest increases in cesarean deliveries from 2000 to 2007 

(57%).

Rates of cesarean delivery typically rise with increasing maternal age. As in 1996 and 2000, the 

rate for mothers aged 40–54 years in 2007 was more than twice the rate for mothers under age 20 

(48% and 23%, respectively).

)LJXUH&HVDUHDQGHOLYHU\UDWHVE\DJHRIPRWKHU8QLWHG6WDWHVDQG

6285&(&'&1&+61DWLRQDO9LWDO6WDWLVWLFV6\VWHP







 



 

































8QGHU ± ±

<HDUVRIDJH

± ± ±

  

3HUELUWKV
NCHS Data Brief ■ No. 35 ■ March 2010

■  3  ■

Cesarean rates rose for women in all racial and ethnic groups from 1996 to 

2007.

All racial and ethnic groups experienced large increases in cesarean rates from 1996 to 2007 

(Figure 3). The rate increased moderately for all groups from 1996 to 2000 (by about 12%), then 

accelerated with each group experiencing increases of around 40% from 2000 to 2007. 

In 2007, cesarean delivery rates were slightly higher for non-Hispanic black women compared

with non-Hispanic white women (34% and 32%, respectively). American Indian or Alaska Native

women had the lowest cesarean delivery rate (28%). 

)LJXUH&HVDUHDQGHOLYHU\UDWHVE\UDFHDQG+LVSDQLFRULJLQRIPRWKHU8QLWHG6WDWHVDQG

6285&(&'&1&+61DWLRQDO9LWDO6WDWLVWLFV6\VWHP

 

 



 

 







 













1RQ+LVSDQLFEODFN 1RQ+LVSDQLFZKLWH +LVSDQLF $PHULFDQ,QGLDQRU

$ODVND1DWLYH

$VLDQRU

3DFLILF,VODQGHU

3HUELUWKV

5DFHDQG+LVSDQLFRULJLQ

  
NCHS Data Brief ■ No. 35 ■ March 2010

■  4  ■

Cesarean rates increased for infants of all gestational ages in the last 

decade.

Cesarean rates increased for births at all gestational ages from 1996 to 2006 (Figure 4). During 

the decade, the cesarean rate for early preterm infants (less than 34 completed weeks of gestation)

increased by 36%. Rates for infants born late preterm (34 to 36 completed weeks of gestation) and

term and over (37 or more completed weeks of gestation) rose by almost 50%. 

From 1996 to 2007, cesarean rates were higher for both early and late preterm infants than for 

term births. 

)LJXUH&HVDUHDQGHOLYHU\UDWHVE\JHVWDWLRQDODJH8QLWHG6WDWHV±

6285&(&'&1&+61DWLRQDO9LWDO6WDWLVWLFV6\VWHP 3HUELUWKV















  

<HDU

  

/HVVWKDQZHHNV

±ZHHNV

ZHHNVDQGRYHU

Cesarean rates varied widely by state.

Rates varied considerably by state. In 2007, cesarean rates ranged from less than 25% in Alaska,

Idaho, New Mexico, and Utah, to over 35% in Florida, Louisiana, Mississippi, New Jersey, and

West Virginia. 

Cesarean rates rose significantly in each state from 1996 to 2007 (see table). The magnitude

of the increases varied. Six states (Colorado, Connecticut, Florida, Nevada, Rhode Island, and

Washington) had increases of over 70%. In 34 states, cesarean delivery rates increased by 50% or 

more. 
NCHS Data Brief ■ No. 35 ■ March 2010

■  5  ■

Table. Cesarean delivery rates, by state: United States, 1996 and 2007 and percent change, 1996–2007

1996 2007

Percent change 

1996–2007

United States 20.7 31.8 54

Alabama 23.3 33.8 45

Alaska 16.7 22.6 35

Arizona 16.1 26.2 63

Arkansas 25.3 34.8 38

California 20.6 32.1 56

Colorado 15.1 25.8 71

Connecticut 19.8 34.6 75

Delaware 21.0 32.1 53

District of Columbia 21.3 32.6 53

Florida 21.6 37.2 72

Georgia 20.9 32.0 53

Hawaii 17.5 26.4 51

Idaho 16.0 24.0 50

Illinois 19.3 30.3 57

Indiana 20.3 29.4 45

Iowa 18.6 29.4 58

Kansas 19.2 29.8 55

Kentucky 21.3 34.6 62

Louisiana 26.4 35.9 36

Maine 20.8 30.0 44

Maryland 21.6 33.1 53

Massachusetts 19.8 33.5 69

Michigan 20.2 30.4 50

Minnesota 16.9 26.2 55

Mississippi 26.6 36.2 36

Missouri 20.4 30.3 49

Montana 19.1 29.4 54

Nebraska 19.8 30.9 56

Nevada 19.3 33.1 72

New Hampshire 20.3 30.8 52

New Jersey 24.0 38.3 60

New Mexico 17.2 23.3 35

New York 22.9 33.7 47

North Carolina 21.1 30.7 45

North Dakota 18.9 28.4 50

Ohio 19.0 29.8 57

Oklahoma 22.5 33.6 49

Oregon 16.9 28.2 67

Pennsylvania 19.4 30.1 55

Rhode Island 17.7 32.2 82

South Carolina 22.6 33.4 48

South Dakota 20.8 26.6 28

Tennessee 21.7 33.3 53

Texas 23.1 33.7 46

Utah 15.9 22.2 40

Vermont 16.5 26.8 62

Virginia 21.1 33.5 59

Washington 16.8 29.0 73

West Virginia 22.8 35.2 54

Wisconsin 15.6 25.0 60

Wyoming 18.3 26.9 47

NOTE: The cesarean rate is the percentage of all live births by cesarean delivery. 
NCHS Data Brief ■ No. 35 ■ March 2010

■  6  ■

Summary

In 2007, approximately 1.4 million women had a cesarean birth, representing 32% of all 

births, the highest rate ever recorded in the United States and higher than rates in most other 

industrialized countries (8).

From 1996 to 2007, cesarean rates increased for all women, regardless of age, race and Hispanic 

origin, or state of residence. In 2006, cesarean delivery was the most frequently performed 

surgical procedure in U.S. hospitals (9). Cesarean rates also increased for infants of all gestational 

ages and may be partly related to the increased rate of multiple births (7), because infants 

in multiple births are much more likely than singletons to be cesarean births (10). However,

cesarean delivery rates for singletons increased substantially more than cesarean rates for infants 

in multiple deliveries (data not shown). 

In addition to clinical reasons, nonmedical factors suggested for the widespread and continuing 

rise of the cesarean rate may include maternal demographic characteristics (e.g., older maternal 

age), physician practice patterns, maternal choice, more conservative practice guidelines, and 

legal pressures (11–13). 

Definitions

Cesarean delivery: Extraction of the infant, placenta, and membranes through an incision in the 

maternal abdominal and uterine walls. 

Cesarean rate: Number of cesarean births per 100 live births.

Race and Hispanic origin: These items are reported separately on birth certificates. Persons of

Hispanic origin may be of any race. Persons of non-Hispanic ancestry are further classified by

race because there are substantial differences in fertility and maternal characteristics between 

Hispanic and non-Hispanic persons. Persons of American Indian or Alaska Native and Asian or

Pacific Islander ancestry are not classified separately by Hispanic origin because the majority of

these persons are non-Hispanic. Multiple race data reported since 2003 were bridged to singlerace categories for trend analysis (7). 

Preterm birth rate: The number of births delivered at less than 37 completed weeks of gestation

per 100 total births.

Early preterm birth rate: The number of births delivered at less than 34 completed weeks of

gestation per 100 total births.

Late preterm birth rate: The number of births delivered at 34 to 36 completed weeks of gestation

per 100 total births.

Rate of term and later births: The number of births delivered at 37 completed weeks of gestation

and over per 100 total births.
NCHS Data Brief ■ No. 35 ■ March 2010

■  7  ■

Data source and methods

This report contains data from the Natality Data File from the National Vital Statistics System 

(NVSS). The NVSS includes information for all live births reported in the United States. 

The Natality Data File is the primary data file for analyzing birth trends and patterns in the 

United States. Data may be accessed from NCHS at http://www.cdc.gov/nchs/data_access/

VitalStatsOnline.htm and http://www.cdc.gov/nchs/VitalStats.htm. 

Terms such as “higher than” and “less than” indicate statistically significant differences.

Computations exclude records with missing data. 

About the authors

Fay Menacker and Brady E. Hamilton are with the Centers for Disease Control and Prevention’s 

National Center for Health Statistics, Division of Vital Statistics, Reproductive Statistics Branch. 

References

1. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2007. National vital 

statistics reports; vol 57 no 12. Hyattsville, MD. National Center for Health Statistics, Released 

March 18, 2009. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf. 

2. U.S. Department of Health and Human Services. Cesarean childbirth. Report of a consensus 

development conference sponsored by the National Institute of Child Health and Human 

Development in conjunction with the National Center for Health Care Technology. September 

22–24, 1980. NIH Publication No.82–2067. 1981. 

3. Yang Q, Wen SW, Oppenheimer L, et al. Association of caesarean delivery for first birth with 

placenta previa and placental abruption in second pregnancy. BJOG 114(5): 609–13. 2007.

4. Kuklina EV, Meikle SF, Jamieson DJ, et al. Severe obstetric morbidity in the United States: 

1998–2005. Obstet Gynecol. 113(2 Part 1):293–9. 2009.

5. Liston FA, Allen VM, O’Connel CM, Jangaard KA. Neonatal outcomes with cesarean 

delivery at term. Arch Dis Child Fetal Neonatal Ed. 93(3): F176–82. 2008. 

6. U.S. Agency for Healthcare Research and Quality. HCUPnet. Healthcare Cost and Utilization 

Project: Rockville, MD. AHRQ 2005 [DRGs 370–3]. 

7. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, et al. Births: Final data for 2006. National 

vital statistics reports; vol 57 no 7. Hyattsville, MD. National Center for Health Statistics. 2009. 

8. Organization for Economic Co-operation and Development. OECD health data 2009: 

statistics and indicators for 30 countries. Paris, France: Organization for Economic Cooperation 

and Development: 2009. Available from: http://www.ecosante.org/index2.php?base=OCDE&lang

h=ENG&langs=ENG&sessionid. 

9. Russo CA (Thompson Reuters), Wier L (Thompson Reuters), Steiner C. (AHRQ). 

Hospitalizations related to childbirth, 2006. HCUP, Statistical Brief # 71. U.S. Agency for 

Healthcare Research and Quality, Rockville, MD. April 2009.
NCHS Data Brief ■ No. 35 ■ March 2010

10. CDC. QuickStats: Percentage of live births by cesarean delivery, by

plurality—United States, 1996, 2000, and 2006. MMWR 58(19):542. 2009.

11. Williams HO. The ethical debate of maternal choice and autonomy in 

cesarean delivery. Clin Perinatol 35:455–62. 2008.

12. Murthy K, Grobman WA, Lee TA, Hall J L. Association between rising

professional liability insurance premiums and primary cesarean delivery 

rates. Obstet Gynecol 110(6):1264–9. 2007.

13. Guise J-M, McDonagh M, Hashima J, et al. Vaginal births after cesarean

(VBAC). Evidence report/technology assessment No. 71 (Prepared by the

Oregon Health & Science university Evidence-based Practice Center under

Contract No. 209–977–0018). AHRQ Publication No. 03–Eoi8,: Agency for

Healthcare Research and Quality. Rockville, MD. March 2003.

Suggested citation

Menacker F, Hamilton BE. Recent trends

in cesarean delivery in the United States. 

NCHS data brief, no 35. Hyattsville, MD:

National Center for Health Statistics. 2010.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

 Director for Science

Division of Vital Statistics

Charles J. Rothwell, M.S., Director

U.S. Department of

Health & Human Services

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

Official Business 

Penalty for Private Use, $300

To receive this publication regularly, contact the 

National Center for Health Statistics by

calling 1–800–232–4636

E-mail: cdcinfo@cdc.gov

Internet: http://www.cdc.gov/nchs

First Class mAIL

Postage & Fees Paid 

CDC/NCHS

Permit No. G-284

ISSN 1941-4927 (Print ed.)

ISSN 1941-4935 (Online ed.)

CS211009

T36066 (03/2010)

DHHS Publication No. (PHS) 2010–1209