The likelihood that an expectant mother will have a cesarean delivery1 is determined in large part by where she lives. An analysis of Blue Cross and Blue Shield (BCBS) companies’ data taken from 3 million deliveries by BCBS commercially-insured members shows that the rate of cesarean deliveries is more than twice as high in some parts of the country than in other parts and that even rates by U.S. Census Division vary by as much as 35 percent.
While geographic variation in cesarean deliveries is stark, the trend nationally may be shifting back toward vaginal deliveries. During a five-year period between July 2010 and June 2015, the cesarean rate decreased slightly each year within the BCBS population, to 33.7 percent from 35.2 percent.
The five-year average rate of cesarean delivery is 34.7 percent, slightly higher than the 32.7 percent rate for the general population as of 2013, based on National Center for Health Statistics data. The contrast likely reflects differences in demographic factors, such as age, associated with the commercially insured and the general population. In this study, mothers insured through BCBS companies are, on average, 30 years old.2 Among the U.S. population, the average age of mothers giving birth is approximately 1.6 years younger, or 28.4 years old, based on NCHS data.
One potential avenue in lowering cesarean rates entails emphasizing vaginal deliveries for as many first-time mothers as possible. When a mother’s first child is delivered by cesarean, the chance is 89 percent that subsequent deliveries will be done by cesarean, based on calculations using NCHS data. About half of the increase in cesarean rates reflect this. Cesarean delivery remains the safest route for breech or multiple births for mother and baby.