Cesarean delivery rates in the United States increased from about 5% in 1965 to 24.7% in 1988, with the majority attributed to four indications: dystocia, fetal distress, previous cesarean delivery and breech presentation. This study calculated one hospital's cesarean delivery rate over a 21-year period to examine the trends in the rate and in their clinical indications. From 1974 to 1979, dystocia was responsible for 39.1% of the 151.2% overall increase in cesarean deliveries at the study hospital, followed by repeat cesarean deliveries (30.1%), fetal distress (8.7%) and breech presentation (3.5%). The percentage of all repeat cesarean deliveries increased, from 6.2 in 1981 to 8.0 in 1990, while the percentage of previous cesarean patients having another cesarean delivery declined from 96.6 in 1981 to 85.5 in 1990. Although there has been a reduction in the proportion of women having repeat cesarean delivery, the number of previous cesarean patients presenting for another delivery has been increasing. The cesarean experience at individual hospitals needs to be examined to provide a better understanding of the reasons for changes in their cesarean delivery rates.