Predictors of primary and overall cesareans by maternal demographic and medical risk factors, 2003-2005

Background: Both overall and primary cesarean rates in the United States are at an all time high and exceed the recommendations of World Health Organization and the goals for Healthy People 2010. The objective of this study was to estimate the odds ratio of overall and primary cesareans in the U.S. adjusted by adequate prenatal care utilization, maternal socio-demographic and medical risk factors, and selected obstetrical procedures. Methods: Random samples were drawn from the public use files of the U.S. Vital Statistics for the years 2003, 2004, and 2005. Multivariate logistic regression was used to estimate adjusted odds ratios of overall and primary cesarean. A subset of women with no reported risk for cesarean was analyzed to estimate the odds of cesarean for women without clinical indications. Results: Black women were 1.18 times more likely than white women to have any cesarean and 1.12 times more likely to have a primary cesarean. The odds of primary cesareans for women with adequate prenatal care utilization were 1.26 times higher than for women with inadequate care. Women older than 35 years of age had 1.64 greater odds of having a cesarean than women under 35. The rate of cesarean for women with no indicated risk was 19.82% overall and 9.48% for primary cesarean. Conclusions: Racial and demographic disparities, prenatal care services utilization, and the rate of cesarean with no indicated risk need further evaluation in order to prevent unnecessary cesareans and improve maternal and infant health outcomes.