National Study Indicates that 45 Percent of Cesarean Sections May Be Unnecessary


Cesarean Sections (C-sections) continue to occur at a high rate in the US despite evidence that they increase poor health outcomes for women and their children. A new nationwide study reveals that 26 percent of US mothers delivered via C-section in 2001, and 45 percent of these deliveries were not considered medically indicated.

The study's lead author, Dr. Whitney P. Witt, director of maternal and child health research at Truven Health Analytics, noted that "Many C-sections are not medically necessary and since these surgical deliveries can be dangerous for both the mother and the baby, the medical community is increasingly concerned about reducing the rate of non-indicated and elective C-sections when possible."

The research team studied how the risk of having a medically indicated and non-medically indicated C-section was affected by many factors – both over the course of a woman’s life and during pregnancy. The researchers examined data on 9,350 pairs of mothers and children from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative sample of children born in 2001 and their mothers. Of the women surveyed, 74 percent had a vaginal delivery, 14 percent had a medically indicated C-section, and 12 percent had a non-indicated C-section.

Important findings from the study include:

• Women were over 100 times more likely to have a non-indicated C-section if they previously had a C-section. However, women were only 20 times more likely to have a medically indicated C-section if they had a prior C-section.
• Women were more likely to give birth via indicated C-section if they experienced any stressful life event prior to pregnancy.
• Obese women were about two times more likely to deliver via C-section than normal weight women.
• Older women were significantly more likely to deliver via C-section than their younger counterparts.
• Women who had chronic conditions or experienced pregnancy complications were more likely to deliver via indicated C-section.

“Women and their doctors should work together to make decisions regarding childbirth. Based on previous research and what we have heard anecdotally, health insurers and hospitals may also need to re-evaluate their policies to increase rates of vaginal birth after cesarean (VBAC)," said Witt. “Furthermore, this study suggests that many risk factors for C-section delivery could be addressed prior to pregnancy, indicating that these discussions should take place before women become pregnant.”

The study also examined MarketScan data from Truven Health Analytics, finding that a C-section delivery costs $4,000 more than a vaginal delivery on average. In fact, reducing the national C-section rate by only 2.8 percent would save approximately $101 million in C-section-related expenditures per year.

The research was funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration and the National Institutes of Health. It has been published in the Maternal and Child Health Journal and is available online at