National Variation in Caesarean Section Rates: A Cross Sectional Study in Ireland

Abstract

ObjectiveInternationally, caesarean section (CS) rates are rising. However, mean rates of CS across providers obscure extremes of CS provision. We aimed to quantify variation between all maternity units in Ireland.MethodsTwo national databases, the National Perinatal Reporting System and the Hospital Inpatient Enquiry Scheme, were used to analyse data for all women delivering singleton births weighing ≥500g. We used multilevel models to examine variation between hospitals in Ireland for elective and emergency CS, adjusted for individual level sociodemographic, clinical and organisational variables. Analyses were subsequently stratified for nullipara and multipara with and without prior CS.ResultsThe national CS rate was 25.6% (range 18.2% ─ 35.1%). This was highest in multipara with prior CS at 86.1% (range 6.9% ─ 100%). The proportion of variation in CS that was attributable to the hospital of birth was 11.1% (95% CI, 6.0 ─ 19.4) for elective CS and 2.9% (95% CI, 1.4 ─ 5.6) for emergency CS, after adjustment. Stratifying across parity group, variation between hospitals was greatest for multipara with prior CS. Both types of CS were predicted by increasing age, prior history of miscarriage or stillbirth, prior CS, antenatal complications and private model of care.ConclusionThe proportion of variation attributable to the hospital was higher for elective CS than emergency CS suggesting that variation is more likely influenced by antenatal decision making than intrapartum decision making. Multipara with prior CS were particularly subject to variability, highlighting a need for consensus on appropriate care in this group.

Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims

“…Working arrangements, such as having laborists, decreased cesarean deliveries or increased trials of labor after cesarean delivery . Likewise, lower multipara CS rates were observed in resource‐rich academic hospitals . In view of access to care, clinicians in rural practice settings or with on‐call anesthesia support were more likely to recommend CS than those in metropolitan areas or with 24 h anesthesia support .…”

Using the Robson 10‐Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives

“…9,10,42 Variation in cesarean rates between institutions may relate to differences in approaches to labor and birth management within an organization. Examples include perinatal care providers' approaches to antenatal decision making regarding elective cesarean birth, 43 characteristics of birth settings, 11,44 differing perinatal care models, 36,45,46 and social interaction effects that normalize intervention rates among neighboring hospitals. 47 Other aspects of birth culture known to affect the likelihood of cesarean include use of intervention during uncomplicated labors, 48 allowance of sufficient time for labor to progress, 49 use of universal electronic fetal monitoring, 50 and differences in care provided by labor and birth unit nurses.…”

Trends and predictors of cesarean birth in Singapore, 2005‐2014: A population‐based cohort study

“…The rise is attributable to both an increase in primary cesarean and a decline in vaginal birth after previous cesarean. [23][24][25][26][27] However, comparable information from Asian countries is limited. [14][15][16] The changing attitude of medical professionals and women toward cesarean, as well as social, cultural, legal, and ethical factors are other contributors to the rising rates of primary cesarean.…”