The transfusion of red cells (RBCs) was analyzed over a 4‐year period (1984–1987), during which 9596 cesarean deliveries were performed. A total of 336 patients were identified as receiving RBC transfusions during or after cesarean delivery; 747 units of RBCs were administered. The overall incidence of transfusion in this patient population declined from 6.2 to 3.2 percent during the study period (p less than 0.001). Slightly more than one‐half (54.4%) of all transfusions were given in the operating room or recovery room. The majority of patients (68.4%) received 2 units of RBCs, 11.6 percent received a 1‐unit transfusion, and 8.3 percent received 5 units or more. The most common obstetric diagnoses associated with RBC transfusion were disorders of placental implantation, preeclampsia, premature labor with tocolytic therapy, fetal distress, and augmentation of dysfunctional labor. In patients without risk factors for bleeding, there was no trend indicating increased transfusion requirements when general anesthesia was employed. In conclusion, this study documents a decline in the transfusion rate during cesarean d