A Comparison of Cesarean Section Frequencies in two Norwegian Hospitals

Abstract

The two largest Norwegian obstetrical departments, in the cities of Bergen and Stavanger, differ markedly with regard to the frequency of Cesarean section. During the 1970's the proportions rose in both departments, but the Stavanger rate remained about half of that in Bergen, the latter following the national average. These differences were not reflected in the perinatal mortality, which had the same rates and fell equally in both hospitals. To search for explanations, all records of Cesarean section cases from the years 1974 and 1979 were studied in both hospitals. We found that mechanical indications, meaning disproportion and prolonged labor, accounted for most of the difference, whereas there was no significant rise in the frequencies for the indication fetal asphyxia in either of the hospitals, these being numerically the most important indications. In fact, there was no significant rise for mechanical indications in Stavanger between 1974 and 1979, whereas in Bergen the increased frequency for this indication gave the highest significance level for any of the seven subgroups of indications. It is suggested that the chain of command may be an important cause of the observed differences between the two departments, although this is not reflected in any stated or conscious policy in either place.

Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study

“…A previous study from Norway showed that decision-making for caesarean section delivery by consultants lowered the caesarean section rates. 22 On call arrangements for each hospital were not explored in this study and the decision-making process for emergency caesarean section may vary across the study hospitals due to varying involvement of a specialist in obstetrics during non-office hours. In some of the study hospitals, a specialist in obstetrics is present in the hospital all the time, whereas in others the specialists are available for consultations only and not present in the hospital during the evening and night.…”

Keisersnitt gjennom 40 år. Overvåking ved hjelp av Medisinsk fødselsregister

“…Stein Tore Nilsen og medarbeidere gjennomgikk journalene for å finne årsa-kene til forskjellen i keisersnittratene; data fra Medisinsk fødselsregister ble brukt til bakgrunnsstatistikk (1). Man ble på forhånd enige om å dele indikasjonene inn i sju grupper.…”

Variation in Obstetric Interventions by Midwife

“…Hurst & Summey 1984, Hayes de Regt et al 1986, Bertollini et al 1987. To understand this phenomenon, which is typical of surgical procedures in general, clinical uncertainty and factors influencing individual physicians' behavior have been suggested to be studied (Chalmers 1979, Nilsen et al 1983, Opit & Selwood 1982, Williams & Chen 1983, Anderson & Lomas 1985, Goyert et al 1989, Lomas & Enkin 1989, pp. 1182-95, Waldenstrom 1989.…”