First Births: A Review of the United States Primary Cesarean Section Rate

The cesarean section rate has increased exponentially worldwide over the past twenty years, and today it is the “most common major surgical procedure in the United States” (Boyle et al., 2013). In 1985, the World Health Organization declared that a cesarean section rate of 10-15% is optimal, and any rates higher than 15% are not medically indicated. This claim was reinvestigated in 2014 by researchers who found that rates exceeding 10% were not accompanied by decreased infant mortality rates, and after 15% did not impact maternal mortality rates (Ye, Betran, Guerrero, Souza, & Zhang, 2014).

The United States total cesarean section rate is 32.2% (Martin, Hamilton, & Osterman, 2015), more than double the WHO recommendation but comparable to other Western countries. The total primary cesarean rate, or the rate of women having their first cesarean delivery, was 22.3% in 2014 (Martin, Hamilton, & Osterman, 2015). The primary cesarean rate is critical because once a woman has a cesarean delivery, it is very likely that all of her subsequent deliveries will also be cesarean. Though there is a growing movement supporting VBACs (vaginal birth after cesarean), in 2014 the national VBAC rate was only 11.3% (Martin, Hamilton, & Osterman, 2015) compared to 28.3% in 1996 (Menacker, 2005). Thus, the majority of primiparous women having a cesarean section with their first birth may never give birth vaginally.

Cesarean sections do save lives, but utilizing cesarean delivery for healthy, low-risk births does not improve outcomes and has a host of negative consequences for mothers. Women who have cesarean deliveries experience more infections and blood clots, longer hospital stays and longer recovery periods, more hospital readmissions, and more chronic pelvic pain than women who have vaginal birth. Complications for infants include respiratory distress syndrome, pulmonary hypertension, and decreased breastfeeding rates. Cesarean sections are also associated with an increased maternal mortality rate and neonatal mortality rate. Lowering the national primary cesarean section rate in low-risk women has become a national health concern (American College of Obstetricians and Gynecologists, 2014).

This paper explores factors contributing to the elevated CS rate, and specifically examines the diagnosis of labor dystocia. The nurse’s role in promoting normal birth and preventing CS is also outlined. Lastly, emerging programs intended to address the elevated CS rate are discussed and evaluated.