Background:American Indian women have one of the lowest cesarean delivery rates among all ethnic groups evaluated in the United States. Our objective was to identify risk factors for cesarean delivery among American Indian women in New Mexico.Methods:Live birth certificate data (1994) from the New Mexico Bureau of Vital Records and Health Statistics were used to compare American Indian women who had a cesarean delivery with those who had a vaginal delivery. We examined demographic, prenatal, and intrapartum factors to determine risk factors for cesarean delivery.Results:In 1994 American Indian women in New Mexico had a cesarean delivery rate of 12 percent. Risk factors for cesarean delivery included age equal to or over 35 years (OR = 1.8, 1.3–2.5) and nulliparity (OR = 1.9, 1.5–2.5). Obstetric risk factors included prematurity (OR = 2.3, 1.5–3.6), low birthweight (OR = 2.6, 1.7–4.2), diabetes (OR = 1.7, 1.1–2.5), pregnancy-induced hypertension (OR = 2.6, 1.8–3.8), and labor and delivery complications (OR = 9.5, 7.5–12.1). Age less than 20 years was negatively associated with cesarean delivery (OR = 0.5, 0.3–0.7).Conclusion:American Indian women have risk factors for cesarean delivery that are similar to those reported in other populations. Future prospective research evaluating intrapartum management may help identify reasons for the low cesarean birth rate.