Surveillance of cesarean section deliveries, New Jersey, 1999-2004

Background: Nationally and in New Jersey, the cesarean delivery rate has been increasing steadily for nearly a decade, and especially since 1999. The purpose of this study was to describe recent trends in cesarean section delivery in New Jersey. Methods: Data on delivery method, medical indications and patient characteristics were extracted from electronic birth certificate files. Results: Cesarean section deliveries increased as a proportion of live births by 6 percent annually. Growth was roughly uniform across Robson's clinical classification. Repeat cesareans contributed only proponionately to the overall trend. The greatest acceleration was observed for procedures without trial of labor and in medical situations where cesarean delivery had been relatively rare. Conclusions: Medical indications recorded on the birth certificate explained little of the rapid growth in utilization of cesarean delivery, since trends were comparable in most categories we examined. A sustained autonomous shift in practice patterns, patient preferences, or both seems the most likely driver of the overall trend.