Primary cesarean delivery rates, by state: results from the revised birth certificate, 2006-2012.

Objectives-This report describes state-specific trends in primary cesarean delivery rates from 2006 through 2012 for reporting areas that implemented the 2003 U.S. Standard Certificate of Live Birth by January 1, 2006, and from 2009 through 2012 for reporting areas that implemented the 2003 revision by January 1, 2009. State-specific changes by gestational age are also explored. Methods-Data for 2006-2012 are based on 100% of singleton births to residents of the reporting areas that implemented the 2003 birth certificate revision by January 1 of each year. Results are not generalizable to the entire United States-the reporting areas do not represent a random sample of U.S. births. Results-The primary cesarean delivery rate for the 2006 reporting area (19 states) increased from 21.9% in 2006 to 22.4% in 2009, and then declined to 21.9% in 2012. For the 2009 reporting area (28 states and New York City), the primary cesarean rate declined from 22.1% to 21.5% during 2009-2012. Rates for 16 of 29 areas declined during 2009-2012; the remaining states were unchanged. By gestational age, state-specific primary cesarean delivery rates at 38 weeks declined for 18 of 29 areas from 2009 to 2012; few state-specific changes were observed at other gestational ages. The primary cesarean delivery rate for the 38 states, District of Columbia, and New York City that were using the revised certificate by January 1, 2012, was 21.5%. State-specific rates ranged from 12.5% (Utah) to 26.9% (Florida and Louisiana). All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.