"During the 1980s, rates of cesarean births rose steadily, with a peak rate of 25 percent of deliveries reported in 1988. Since then, the rate has been slowly decreasing, with the majority of the decline attributable to a reduction in the rates of primary cesarean births. In 1989, the rate of vaginal births among women who had a previous cesarean birth was 19 percent; in 1995 it increased to 28 percent.[Curtin, S.C. Rates of cesarean birth and vaginal birth after previous cesarean, 1991�95. Monthly Vital Statistics Report 45(Suppl. 3)(11):1-12, 1997.] The improvements are likely to be attributable to use of such strategies as clearer guidelines for trials of labor and labor management, continual labor support, and focused attention on physician practice patterns.[Main, E.K. Reducing cesarean birth rates with data-driven quality improvement activities. Pediatrics 103:374-383, 1999. PubMed; PMID 9917479]

Expert opinion called for use of risk-adjusted rates of cesarean births (that is, rates standardized by patient characteristics) to monitor progress over time.[ACOG, Task Force on Cesarean Delivery. Considerations in Evaluating the Incidence of Cesarean Delivery. Washington DC: ACOG, in press] (The targets presented here apply to the population as a whole and are not intended to be used as practice outcome objectives for individual physicians or institutions, as the medical needs of the patients in each practice will vary.) In addition to monitoring rates of cesarean births, the outcomes of these deliveries (for both the mother and the infant) should be watched closely to assure that changes in the mode of delivery do not put women or their infants at risk."

The following table shows the Healthy People 2010 Objective for cesarean section outcomes:

Cesarean Section Rate	2010 Objective
Low-Risk Women Giving Birth for the First Time	15.0
Low-Risk Women with a Prior Cesarean (i.e, Repeat Cesarean)	63.0
Source: http://www.healthypeople.gov/Document/HTML/Volume1/09Family.htm

The California County Profile Reports include information on both first-time cesareans and repeat cesareans.

Definitions

A live birth is said to be delivered via first time cesarean section if the mother had no previous deliveries, and the delivery is low-risk.

A live birth is said to be delivered via repeat cesarean section if the delivery is low-risk, and the mother has previously delivered via cesarean.

A Low-Risk delivery is defined as one for a full-term (at least 37 weeks since LMP), singleton (not a multiple pregnancy), vertex fetus (head facing in a downward position in the birth canal).

Tables and Figures

Number and Percent of First Time Cesarean Sections by Race/Ethnicity, California and Imperial County, 2007

Race/Ethnicity	Imperial County			California
Race/Ethnicity	N	Denominator	%	N	All Births	%
Hispanic	251	816	30.8	18,413	74,224	24.8
Non-Hispanic White	27	79	34.2	12,921	49,857	25.9
Non-Hispanic Black	7	10	70.0	2,207	7,590	29.1
Non-Hispanic Asian/Pacific Islander	3	8	37.5	6,158	23,587	26.1
Non-Hispanic Other Race	3	3	100.0	1,672	6,481	25.8
Overall	291	916	31.8	41,371	161,739	25.6

Births with unknown values are not included
Categories with less than 10 live births are grayed
Source: California Department of Public Health (CDPH)

Percent of First Time Cesarean Sections, Imperial County, 2005-2007

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Source: California Department of Public Health (CDPH)

Percent of First Time Cesarean Sections, California and Imperial County, 2005-2007

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Source: California Department of Public Health (CDPH)

Number and Percent of Repeat Cesarean Sections by Race/Ethnicity, California and Imperial County, 2007

Race/Ethnicity	Imperial County			California
Race/Ethnicity	N	Denominator	%	N	All Births	%
Hispanic	401	402	99.8	28,315	29,778	95.1
Non-Hispanic White	38	38	100.0	12,793	13,672	93.6
Non-Hispanic Black	6	6	100.0	2,280	2,450	93.1
Non-Hispanic Asian/Pacific Islander	2	2	100.0	5,480	5,901	92.9
Non-Hispanic Other Race	1	1	100.0	1,586	1,697	93.5
Overall	448	449	99.8	50,454	53,498	94.3

Births with unknown values are not included
Categories with less than 10 live births are grayed
Source: California Department of Public Health (CDPH)

Percent of Repeat Cesarean Sections, Imperial County, 2005-2007

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Source: California Department of Public Health (CDPH)

Percent of Repeat Cesarean Sections, California and Imperial County, 2005-2007

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Source: California Department of Public Health (CDPH)

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IPODR - California County Profile Report