Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History: New Data From the Birth Certificate, 2013

A new NCHS report presents recent findings for 2013 on four maternal morbidities associated with labor and delivery—maternal transfusion, ruptured uterus, unplanned hysterectomy, and intensive care unit (ICU) admission—that are collected on birth certificates for a 41-state and District of Columbia reporting area, which represents 90% of all births in the United States.

Key Findings from the Report:

• Rates of maternal morbidity were higher for cesarean than vaginal deliveries—rates of transfusion (525.1 per 100,000) and ICU admission (383.1) were highest for primary cesarean deliveries, while rates of ruptured uterus (88.9) and unplanned hysterectomy (143.1) were highest for repeat cesarean deliveries.
• Higher rates of maternal morbidity for cesarean compared with vaginal deliveries were found for nearly all maternal age groups and for women of all races and ethnicities.
• Women with no previous cesarean delivery who had vaginal deliveries had lower rates for all maternal morbidities compared with those who had cesarean deliveries.
• Women with a previous cesarean delivery who labored and had vaginal birth generally had lower rates for most of the morbidities, but failed trials of labor were generally associated with higher morbidity than scheduled repeat cesarean deliveries, especially for ruptured uterus, which was seven times higher (495.4 per 100,000 compared with 65.6).