Low-risk Cesarean Delivery

Cesarean deliveries are often performed because of complications during pregnancy or delivery that make vaginal birth unsafe for the mother or the fetus, such as a previous cesarean delivery, the fetus being in breech position, multiple births (e.g., twins, triplets), an infection like HIV, or medical conditions like preeclampsia, diabetes, or hypertension.19, 20, 21 A cesarean delivery may increase the risk of adverse health outcomes, such as infection, blood loss, blood clots, and complications in future pregnancies for the mother and breathing problems, gastrointestinal symptoms, and surgical injury for the infant.19 In 2014, the American College of Obstetrician and Gynecologists and the Society for Maternal-Fetal Medicine released a joint statement raising concerns that cesarean delivery is overused in the United States.22 However, the overall cesarean delivery rate has increased in recent years.23 A cesarean delivery is considered low-risk if a single infant is delivered head-first at full-term to a first-time mother. Low-risk cesarean deliveries vary by maternal race and Hispanic origin, maternal age, and urbanicity.

Figure 11. Low-risk cesarean delivery rate by maternal race and Hispanic origin, 2016–2022
Low-risk cesarean delivery rate by maternal race and Hispanic origin, 2016–2022

NOTE: NH = non-Hispanic origin; NHOPI = Native Hawaiian or Other Pacific Islander; AIAN = American Indian or Alaska Native. Low-risk cesarean rate is the number of singleton, term (37 or more completed weeks of gestation based on the obstetric estimate), cephalic, cesarean deliveries to women having a first birth per 100 women delivering singleton, term, cephalic, first births. Race and Hispanic origin refer to the mother's race and Hispanic origin. The 1997 U.S. Office of Management and Budget standards for data on race and ethnicity were used to classify people into one of the following five racial groups: White, Black or African American, Asian, American Indian or Alaska Native, or Native Hawaiian or Other Pacific Islander. All categories are single race. Data on race and Hispanic origin are collected and reported separately. People of Hispanic origin may be of any race.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Natality.

  • From 2016 (25.7%) to 2022 (26.3%), the total low-risk cesarean delivery rate did not change.
  • For Native Hawaiian or Other Pacific Islander, non-Hispanic women, the low-risk cesarean delivery rate did not change significantly from 2016 to 2019 and then increased from 26.1% in 2019 to 30.1% in 2022.
  • Although the low-risk cesarean delivery rate did not change significantly for any other race and Hispanic origin group from 2016 to 2022, there were differences for some groups from 2021 to 2022.
  • From 2021 to 2022, the low-risk cesarean delivery rate increased for Asian, non-Hispanic women (from 28.4% to 29.2%) and decreased for Black, non-Hispanic women (from 31.2% to 30.8%). No significant changes were seen for other race and Hispanic origin groups from 2021 to 2022.

Figure 12. Low-risk cesarean delivery rate by maternal age, 2016–2022
Low-risk cesarean delivery rate by maternal age, 2016–2022

NOTE: Low-risk cesarean rate is the number of singleton, term (37 or more completed weeks of gestation based on the obstetric estimate), cephalic, cesarean deliveries to women having a first birth per 100 women delivering singleton, term, cephalic, first births.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Natality.

  • From 2016 to 2022, the low-risk cesarean delivery rate decreased for adolescents ages 15–19 (from 17% to 16%) and women ages 20–24 (from 22% to 21%) but did not change significantly for women ages 25 and older.
  • Throughout the period, the low-risk cesarean delivery rate increased with age. In 2022, the rate was highest for women ages 40 and older (53%), followed by women ages 35–39 (39%), 30–34 (30%), 25–29 (26%), 20–24 (21%), and 15–19 (15%).

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19 Gregory, K. D., Jackson, S., Korst, L., & Fridman, M. (2012). Cesarean versus vaginal delivery: Whose risks? Whose benefits?. American journal of perinatology, 29(01), 07–18. DOI: http://dx.doi.org/10.1055/s-0031-1285829.

20 American College of Obstetricians and Gynecologists. (2024). Preeclampsia and high blood pressure during pregnancy. https://www.acog.org/womens-health/faqs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy.

21 American College of Obstetricians and Gynecologists. (2024). Gestational diabetes. https://www.acog.org/womens-health/faqs/gestational-diabetes.

22 Caughey, A. B., Cahill, A. G., Guise, J. M., Rouse, D. J., & American College of Obstetricians and Gynecologists. (2014). Safe prevention of the primary cesarean delivery. American journal of obstetrics and gynecology, 210(3), 179–193. DOI: https://doi.org/10.1016/j.ajog.2014.01.026.

23 Osterman, M. J. K., Hamilton, B. E., Martin, J. A., Driscoll, A. K., & Valenzuela, C. P. (2023). Births: Final data for 2021. National Vital Statistics Reports, 72(1). https://doi.org/10.15620/cdc:122047.

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