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Effect of decreasing cesarean births on maternal age-, parity- and ethnicity-associated cesarean rates.

OBJECTIVE
To evaluate the effect of decreasing cesarean births on the rates associated with maternal age, parity and ethnicity.


STUDY DESIGN
During 1991-1997, 14,689 women delivered at our community hospital, 2,945 by cesarean (20.0%). The clinical and demographic characteristics of these women and their newborns were studied. The data were divided according to maternal age, parity and ethnicity. As cesareans began to decrease in our service during 1994, the data were also divided into two groups: group 1 (1991-1993) and group 2 (1994-1997). chi 2 analysis was used to evaluate the differences between the proportions. A P value < .05 was considered significant.


RESULTS
Maternal and perinatal outcomes and some demographic characteristics did not change, while cesarean rates decreased. As compared to group 1, cesarean birth rates decreased in group 2, from 22.5% to 17.9% (P < .0001). The decrease was significant in every maternal age-, parity- and ethnicity-related subgroup, except for women with parity > 4 (16.7% vs. 16.3%, P = .835) and those > or = 36 years old (31.6% vs. 30.9%, P = .798); for them, cesarean birth rate for breech presentation increased in group 2 (1.3-4.7%, P = .002).


CONCLUSION
Cesarean birth rates can be reduced safely, and further studies should determine the factors associated with higher cesarean rates among older women.