First-Time Cesarean Deliveries Increased in Recent Years

Cesarean deliveries have increased in the U.S. over the last few years, driven by a rise in patients who underwent first-time C-sections, according to a CDC report.

While the rate of primary C-sections fluctuated from 2016 to 2019, it increased from 2019 to 2021 among women in all age groups, reported Michelle Osterman, MHS, of the CDC’s National Center for Health Statistics.

The primary cesarean rate reached 22.4% in 2021, Osterman wrote in Vital Statistics Rapid Release.

Primary cesarean rates increased 4% among women in their 20s, 2% in women ages 30 to 34, and 1% in women ages 35 to 39.

While primary C-section rates increased among all racial and ethnic groups from 2019 to 2021, the increase was not significant for American Indian and Alaskan Native women. Within the 2-year period, increases ranged from approximately 3% among white and Asian women, to 14% among Native Hawaiian and other Pacific Islander women.

The repeat cesarean rate, however, which captures patients who have multiple procedures, steadily decreased by around 1% each year from 2016 to 2021 (87.6% to 85.9%), Osterman noted. Repeat cesarean delivery rates decreased specifically for women ages 25 to 39, those who identified as white or Hispanic, and those with full- or late-term pregnancies.

The increase in overall C-sections likely would have been higher if not for the decrease in repeat procedures, she said.

“Because 7 to 9 out of 10 pregnant folks with a prior cesarean will have a repeat cesarean, we can anticipate an overall climb in the overall cesarean delivery rate for the years ahead,” Kjersti Aagaard, MD, PhD, an ob/gyn at Baylor College of Medicine and Texas Children’s Hospital in Houston, told MedPage Today.

Understanding the reasons why the primary C-section rate increased will “of course be the work ahead of us,” she said, noting that 97% of C-sections are medically indicated.

Aagaard pointed out that primary cesarean delivery by maternal request is rare, and accounts for less than 3% of all cesarean deliveries in the U.S., so the increase in C-sections is not due to “elective” procedures.

“Given the coincident timing with the COVID pandemic, and knowing the disproportionate risk pregnant folks with COVID face for severe disease, one question will be whether severe maternal disease played a role in the small but significant increase in primary cesarean delivery rates,” she said.

This CDC report is based on U.S. birth certificate data collected through the National Vital Statistics System. While data from 2021 are provisional, data from 2016 to 2020 are final.

  • Amanda D’Ambrosio is a reporter on MedPage Today’s enterprise & investigative team. She covers obstetrics-gynecology and other clinical news, and writes features about the U.S. healthcare system. Follow


Osterman reported no conflicts of interest.

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