Background: In 2017 Georgia’s cesarean delivery(c-section) rate is 34.2%, slightly higher than that of the United States (32.0%) and unlikely to meet the Healthy People 2020 target (24.9%). Georgia also has one of the highest maternal mortality rates in the Nation and c-section delivery is associated with an increased risk of maternal death. The objective of this study was to identify potentially actionable risk factors associated with c-sections in Georgia.

Methods: Data from 2014 to 2015 Georgia Birth Certificates were used to assess the risk factors associated with having a c-section. We examined the epidemiology of primary c-section in regard to potential risk factors. Bivariate analysis was used to assess the independent associations between risk factors and c-sections included on the Georgia birth certificate.

Results: The total births for the two years was 262,109 and 33.7% were delivered by c-section. Among these, 21.7% were primary c-sections and 12% were repeat c-sections. Of the women who underwent a primary c-section, 5.22% were diagnosed with gestational diabetes and 7.74% were diagnosed gestational hypertension. Increased risk for primary c-section included being African American (RR=1.14; 95% CI: 1.12-1.16) when compared to white non-Hispanic, having private insurance (RR=1.20; 95% CI: 1.18-1.22), and being a college graduate (RR=1.21; 95% CI: 1.18-1.24).

Conclusion: This primary analysis identified risk factors associated with primary c-sections that may provide insights on potential strategies to reduce the rate of primary c-sections in Georgia. Additional research is needed to identify the difference between links between c-sections and maternal mortality.