Primary elective C-section up 20% from 1999 to 2001; VBAC rate at 12.7%: overall C-section rate is at a record 26.1%.

The rate of primary elective cesarean sections is on the rise.

Among women with no prior history of cesarean section, the rate rose almost 20% between 1999 and 2001, from 1.56% to 1.87%. Primary elective or "patient choice" C-sections now comprise 22% of primary preplanned cesarean deliveries, according to a report issued by HealthGrades, a health care quality company.

Overall C-section rates continue to rise, up 7% since 2001, with the national rate at a record 26.1%, the Centers for Disease Control and Prevention reported in preliminary data for 2002. Meanwhile, the vaginal birth after cesarean section (VBAC) rate continues to drop sharply, down 29% from 16.4% in 2001 to 12.7% in 2002 (Natl. Vital Stat. Rep. 51[11]:1-20, 2003).

The national C-section rate of 26.1% in 2002 is an "all-time record, and part of that is patient-choice cesarean," Dr. Bruce L. Flamm, area research chairman and a practicing ob.gyn, at the Kaiser Permanente Medical Center in Riverside, Calif., said in an interview.

The HealthGrades study defined primary patient-choice cesarean sections as first-time C-sections in women who have not labored, have no prior history of C-section, and have no medical indications for C-section. The study, which included 1,920 hospitals in 18 states, found that the rate of primary patient-choice cesareans in 2001 was 1.87% among women with no prior history of C-section. This extrapolates to about 62,970 women nationwide.

In evaluating the appropriateness of primary, preplanned C-sections in various hospitals, the investigators tried to determine how many patients who underwent a C-section actually had a medical indication for the procedure. "No one has really been tracking that particular patient subgroup," said Dr. Samantha Collier, vice president of medical affairs at HealthGrades, Denver.

Although the study did not address why the rate of primary elective C-sections is increasing, Dr. Collier noted that two factors may play a role: the perceived long-term consequences of vaginal delivery and the perception that the risks of C-section and vaginal delivery are equal.