Estimating the Effect of Cesarean Section Rate on Health Outcome

Abstract

This paper tests the null hypothesis of a zero effect of cesarean section rate on health outcome against the alternative of a positive effect. Using data from 59 hospitals in Sweden from 1988-92, we specify two separate linear regression models for health outcome, one with perinatal mortality, and the other with rate of asphyxia, as dependent variable. We estimate the models by single-year cross-section regressions and as pooled data systems. The null hypothesis cannot be rejected, i.e., we do not find any significant positive effect of cesarean section rate on health outcome. Thus, we conclude that an increase in cesarean section rate does not imply lower perinatal mortality or lower rate of asphyxia. This in turn indicates that the minimum cesarean section rate is optimal.

Rates of Cesarean Births in Hong Kong: 1987–1999

“…It is doubtful that surgical intervention during labor and delivery contribute to better outcomes; at best, cesarean section is a useful adjunct in keeping mortality low. The literature supports the contention that high rates of instrumental or surgical deliveries are not associated with improved perinatal outcomes (23,27‐31). Nonetheless, we should not completely dispel the alternative explanation that modern obstetric interventions, other than cesarean section or assistance with forceps and suction, contributed to the fall in the mortality indices.…”

“…Given the lack of data on individual mother‐infant pairs, and the limited number of data points available (i.e., 8 years), on an aggregate level we were unable to control for these potential confounders through study design, stratification of results, or post‐hoc adjustment using multivariate techniques such as regression analysis. Furthermore, a descriptive, correlational study such as this one cannot establish cause and effect, although most components of our observations have been examined with other designs and in different settings (9,10,23,27‐32). Despite these potential shortcomings inherent in a population‐level study with a limited sample size, the associations we found, and also perhaps those we did not include, suggest the urgent need for further investigation into which factors related to the doctors' and women's decision‐making processes influence cesarean section rates.…”

Variation in cesarean section rates is not related to maternal and neonatal outcomes

“…The ideal rate of CS for the average population in a high‐resource country is controversial. A World Health Organization consensus conference stated that the CS rate should not exceed 10–15% in any population, which has been confirmed by several authors . However, there have been concerns that if a CS rate of only 10–15% is aimed at, the wellbeing of the neonate might be endangered .…”

“…As well as the rate of CS, the incidence of maternal and neonatal complications varies markedly from hospital to hospital, even within the same country . There are some well‐known maternal and obstetric factors which increase the risk of maternal complications in CS .…”

From therapeutic to elective cesarean deliveries: factors associated with the increase in cesarean deliveries in Chiapas

“…Regardless of the region, healthcare professionals consider higher rates to be unjustified in light of the frequency of obstetric complications [2–4]. Nevertheless, cesarean sections (C-sections) are among the most common surgeries performed, with increasing frequencies being observed in developed and developing countries [5–9].…”