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