{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:51:51Z","timestamp":1790913111013,"version":"4.1.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Reducing rates of unnecessary cesarean deliveries is both a national and a global health objective. However, there are limited national US data on trends in indications for low-risk cesarean delivery.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine temporal trends in and indications for cesarean delivery among patients at low risk for the procedure over a 20-year period.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study analyzed 2000 to 2019 delivery hospitalizations using the National Inpatient Sample. Births at low risk for cesarean delivery were identified using a definition from the Society for Maternal-Fetal Medicine and additional criteria. Temporal trends in cesarean birth were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% CIs. Data analysis was performed from August 2022 to January 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>This analysis evaluated cesarean birth trends in a population at low risk for this procedure over a 20-year period.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>In addition to overall cesarean birth risk, cesarean deliveries for nonreassuring fetal status and labor arrest were individually analyzed.<\/jats:p><\/jats:sec>Results<\/jats:title>Of an estimated 76.7 million delivery hospitalizations, 21.5 million were excluded according to the Society for Maternal-Fetal Medicine definition, and 14.7 million were excluded according to additional criteria. Of the estimated 40\u202f517\u202f867 deliveries included, 12.1% (4\u202f885\u202f716 deliveries) were by cesarean delivery. Cesarean deliveries among patients at low risk for the procedure increased from 9.7% to 13.9% between 2000 and 2009, plateaued, and then decreased from 13.0% to 11.1% between 2012 and 2019. The AAPC for cesarean delivery was 6.4% (95% CI, 5.2% to 7.6%) from 2000 to 2005, 1.2% from 2005 to 2009 (95% CI, \u22121.2% to 3.7%), and \u22122.2% from 2009 to 2019 (95% CI, \u22122.7% to \u22121.8%). Cesarean delivery for nonreassuring fetal status increased from 3.4% of all deliveries in 2000 to 5.1% in 2019 (AAPC, 2.1%; 95% CI, 1.7% to 2.5%). Cesarean delivery for labor arrest increased from 3.6% in 2000 to a peak of 4.8% in 2009 before decreasing to 2.7% in 2019. Cesarean deliveries for labor arrest increased during the first half of the study (2000-2009) for the active phase (from 1.5% to 2.1%), latent phase (from 1.1% to 1.5%), and second stage (from 0.9% to 1.3%) and then decreased from 2010 to 2019, from 2.1% to 1.7% for the active phase, from 1.5% to 1.2% for the latent phase, and from 1.2% to 0.9% for the second stage.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Cesarean deliveries among patients at low risk for cesarean birth appeared to decrease over the latter years of the study period, with cesarean deliveries for labor arrest becoming less common.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.5428","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T17:16:01Z","timestamp":1680110161000},"page":"e235428","source":"Crossref","is-referenced-by-count":20,"title":["Cesarean Delivery Trends Among Patients at Low Risk for Cesarean Delivery in the US, 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