Elsevier

Obstetrics & Gynecology

Volume 91, Issue 6, June 1998, Pages 1013-1018
Obstetrics & Gynecology

Original Articles
Effect of Departmental Policies on Cesarean Delivery Rates: A Community Hospital Experience

https://doi.org/10.1016/S0029-7844(98)00077-5Get rights and content

Abstract

Objective: During 1994, our department adopted several strategies in an attempt to decrease our cesarean delivery rates. This study evaluates the effect of these changes on our cesarean delivery rates.

Methods: We studied data of women who delivered at our community hospital obstetric unit over a period of 6 years, from January 1, 1991, to December 31, 1996. During 1994, our department adopted labor management and cesarean delivery guidelines, with review of every cesarean delivery that did not meet guidelines and confidential individual feedback; established 24-hour in-house coverage; and attempted to achieve the goal of an annual cesarean delivery rate of less than 15%. These data were evaluated by χ2 analysis. Women who delivered in the first 3 years (group A) were compared with those who delivered in the second 3 years (group B) (ie, when the changes occurred). P < .05 was considered significant.

Results: Groups A and B shared similar demographic characteristics. The total cesarean delivery rate decreased from 22.5% (group A) to 18.6% (group B) (P = .001), whereas the primary cesarean delivery rate decreased from 13.5% to 10.6% (P = .001) and the repeat cesarean delivery rate decreased from 9.0% to 7.9% (P = .03). The proportion of women who received oxytocin and regional anesthesia and underwent vacuum-assisted deliveries increased (P < .001), whereas perinatal mortality and morbidity did not change.

Conclusion: The cesarean delivery rate safely decreased. These data suggest the importance of the commitment of attending physicians to a lower cesarean delivery rate, of service improvements, and of detailed feedback.

Section snippets

Materials and methods

Ravenswood Hospital Medical Center is a 480-bed, acute-care teaching hospital located on Chicago’s North Side. Between January 1, 1991, and December 31, 1996, there were 12,912 deliveries on our unit. A review of these records was conducted. Demographic characteristics, cesarean delivery indications, other obstetric procedures, perinatal mortality and morbidity, birth trauma, low Apgar scores, and admissions of newborns (2500 g and more) to the special care nursery (neonatal intensive care unit

Results

From January 1, 1991, through December 31, 1996, there were 12,912 deliveries on our unit, 2669 (20.7%) of them by cesarean. Group A and group B shared similar demographic characteristics (Table 1). No changes related to maternal age, parity, or ethnic background were found. However, compared with group A, group B (the study group) had more women with health maintenance organization (HMO) coverage (29.6 versus 27.2%, P = .002) and Blue Cross coverage (13.2 versus 11.8%, P = .016) and fewer

Discussion

Our cesarean delivery rate decreased during the study period with no apparent adverse effects. The demographic characteristics of the women during both periods (A and B) did not change. Private insurance has been associated with increased cesarean delivery rates;1., 2., 3., 4., 5., 8., 11. however, our cesarean delivery rates decreased. We performed 328 fewer cesarean deliveries during this period than we would have if the 1991 rate of 23.2% had been maintained. In 1993, the charge for a

References (26)

  • K. O’Driscoll et al.

    Correlation of decrease in perinatal mortality and increase in cesarean rates

    Obstet Gynecol

    (1983)
  • D.B. Petitti

    Maternal mortality and morbidity in cesarean section

    Clin Obstet Gynecol

    (1985)
  • Department of Health and Human Services. Cesarean childbirth: Report of a consensus development conference. 1980 Sept...
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