A nationally representative survey has been completed by ACOG to determine the cesarean childbirth rates in the U.S. and current hospital policies regarding ceasarean childbirth. Members of the EB staff acted as consultants to ACOG to assist in the design of the survey, sampling methodology and analysis of the results. The purpose of the survey was to evaluate changes since 1979 in rates of cesarean delivery and trial of labor after a previous cesarean. Questionnaires were mailed to 538 hospitals and 87% responded. In 1979, 2.1% of women with a prior cesarean birth were given a trial of labor. By 1984, the rate increased four-fold to 8.0%. Over 50% of the trials of labor resulted in a successful vaginal delivery. However, the fraction of hospitals with no trials of labor remains high (54%). Cesarean birth rates increased from 14.1% in 1979 to 19.0% in 1984. Fetal distress accounted for a larger proportion of primary cesareans in 1984 (21%) as compared to 1979 (14%). The observed increase in the rate of trial of labor does not appear to be large enough to stem the rising cesarean delivery rate. The present survey and other national surveys provide no evidence that the cesarean delivery rates are leveling off or decreasing. In addition to this survey, NICHD had obtained information from the Commission on Professional Hospital Activities on national rates of cesarean childbirth that will be comparable to information obtained by the institute in 1980.