156 Trends in cesarean delivery on maternal request in the United States from 1999 to 2015

Abstract

The rate of cesarean delivery has increased in the United States over the last several decades. The rate of cesarean delivery on maternal request (CDMR) however remains uncertain. The objectives of this study were to describe the prevalence and temporal trends of CDMR in the United States, and to characterize the population of patients who elect to undergo a CDMR. A retrospective cohort study was conducted using data from The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999 to 2015. An algorithm based on International Classification of Diseases, Ninth Revision (ICD-9) codes was created to identify patients who delivered by primary elective cesarean section in the absence of fetal or maternal indications. Maternal demographic characteristics between patients who delivered by CDMR and patients who did not were compared. Of the 13,698,836 deliveries included over the study period, 221,310 were identified as potential CDMR. CDMR rates peaked in 2009, and varied from 1% to 1.98% of all live births and 4.53% to 5.88% of all cesarean deliveries over the study period. Overall, the rate of CDMR among all live births increased over the study period, from 1% in 1999 to 1.56% in 2015 (p <0.0001). Patients who elected to deliver by CDMR were more likely to be over the age of 35, in the highest income quartile, and have private insurance, and were less likely to be African American (p <0.0001). Our findings indicate that CDMR accounts for a small proportion of all deliveries in the United States. Furthermore, rates of CDMR have increased only slightly since 1999. CDMR is more prevalent among patients with certain demographic characteristics. These results may indicate that the option of CDMR is more appealing or more frequently offered to a certain population of patients.