A. A nationally representative survey has been completed to determine the cesarean childbirth rates in the U.S. and current hosptial policies regarding cesarean childbirth. Members of the EB staff acted as consultants to ACOG to assist in the design of the survey, sampling methodology and analysis of the results. The purpose of the survey was to evaluate changes since 1979 in rates of cesarean delivery and trial of labor after a previous cesarean. Questionnaires were mailed to 538 hospitals and 87% responded. In 1979, 2.1% of women with a prior cesarean birth were given a trial of labor. By 1984, the rate increased four-fold to 8.0%. Over 50% of the trials of labor resulted in a successful vaginal delivery. However, the fraction of hospitals with no trials of labor remains high (54%). B. In addition to this survey , NICHD has obtained information from the Commission on Professional and Hospital Activities on national rates of cesarean childbirth. The cesarean delivery rate steadily increased from 9.1% in 1974 to 14.7% in 1978, and to 21.2% in 1984. One-third of the rise in the cesarean rate from 1974-1978 was due to repeat cesareans, and 9% was due to fetal distress. Since 1978, 47% of the rise in the cesarean rate was attributed to repeat cesareans, and 16% to fetal distress. Less of the recent rise in the cesarean rate was due to dystocia and breech presentation. The rate of cesarean delivery among those with a previous cesarean was 96%.
