Temporal variation in rates of cesarean section for dystocia: Does “convenience” play a role?

Fraser, William D.; Usher, Robert H.; McLean, Frances H.; Bossenberry, Carol; Thomson, Mary Ellen; Kramer, Michael S.; Smith, L.P.; Power, Hugh

doi:10.1016/0002-9378(87)90272-9

Cited by 71 publications

(21 citation statements)

References 6 publications

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“…These point to economic incentives as the most important driving force behind increasing rates of caesarean section. Several studies 27–30 suggest that physicians prefer caesarean to vaginal delivery because it allows them ‘to work a minimum of non‐social hours’. Such less obvious incentives like convenience and leisure may motivate physicians to convince families for a caesarean section as an immediate life‐saving proposition.…”

Section: Discussionmentioning

confidence: 99%

High caesarean rates in Madras (India): a population‐based cross sectional study

Sreevidya

Sathiyasekaran

2003

BJOG

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Objective To estimate the population caesarean section rate in urban India.Design Population-based cross sectional study.Setting Madras City (Chennai), India.Sample Seven hundred and eighty resident women who delivered in Madras between June 1997 and May 1999. Methods Cluster sampling was done using streets as cluster units. Thirty clusters were selected from 1255 clusters by the probability proportion to size method and 26 women were selected randomly from each cluster. Main outcome measures Total and primary caesarean rates.Results Total population caesarean section rate was 32.6% (95% CI 27-38) and primary caesarean section rate was 25% (95% CI 20 -30). Total caesarean section rates in the public, charitable and private sectors were 20%, 38% and 47%, respectively. Private sector deliveries had an odds ratio of 2.4 (95% CI 1.5, 3.8) of a primary caesarean section delivery in comparison with the public sector after adjustment for parity, age at delivery of mother and educational status. Conclusions Forty-seven percent of births by caesarean section in the private sector is alarming and could implicate private sector care as the main contributing factor behind the high population caesarean section rates. Policymakers should urgently institute systems for accountability and ethical practice and regularly monitor all medical interventions, before large scale exploitation of the rural markets begins.

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Section: Discussionmentioning

confidence: 99%

High caesarean rates in Madras (India): a population‐based cross sectional study

Sreevidya

Sathiyasekaran

2003

BJOG

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“…Phillips, Thornton, and Gleicher (1982) also found lower weekend deliveries, but no differences between weekend and weekday rates of C-section for dystocia in a New York teaching hospital. Finally, Fraser et al (1987) found that C-sections were performed for dystocia significantly more often in the evening (6 PM to midnight) than at other times at a McGill teaching hospital, especially for patients with fewer than 16 hours of labor. Reducing the evening rates for dystocia to other rates would have decreased the overall primary C-section rate by only 0.7 percentage points.…”

Section: Costs To Physicians Of Vaginal Deliveries and Cesarean Sectionsmentioning

confidence: 93%

Economic Incentives in the Choice between Vaginal Delivery and Cesarean Section

Keeler¹,

Brodie²

1993

The Milbank Quarterly

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The dramatic rise in cesarean-section (C-section) rates, and their high costs and wide variation, has raised interest in understanding the factors affecting decisions to use this procedure. The economic incentives of physicians, hospitals, payers, and mothers are examined. In the economic framework, physicians must balance their short-term interests against their reputation, which is derived from efficiently providing what mothers want. Providers who encounter higher opportunity costs while attending to mothers in prolonged labor can reduce these costs by operating or by restructuring their practices. The mainly indirect evidence on financial incentives indicates that insured mothers have low marginal financial costs when they undergo C-section. Mothers with private, fee-for-service insurance have higher C-section rates than mothers who are covered by staff-model HMOs, who are uninsured, or who are publicly insured. In conclusion, research and payment reforms to reduce distortions to good practice are proposed.

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“…Studies of weekend heart attacks build on earlier evidence of distortions in medical practice on weekends and during evening hours [15,16]. In light of the potential for selection bias arising from deferred hospitalization, researchers must exercise caution when interpreting the observed associations between weekend hospitalization and health outcomes.…”

Section: Five-year Viewmentioning

confidence: 99%

Weekend hospitalization and mortality: a critical review

Becker¹

2008

Expert Review of Pharmacoeconomics & Outcomes Research

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Numerous studies have documented a positive association between weekend hospitalization and mortality. Some researchers have argued that these associations are causal and arise from weekend reductions in hospital staffing. Others have suggested that the observed correlations reflect differences in the unobservable characteristics of weekend versus weekday patients. The existing literature has provided only limited evidence of the specific pathways through which weekend hospitalization might affect health outcomes. This article outlines the limitations of the existing research and highlights the need for in-depth condition-specific studies that acknowledge the potential threat posed by selection bias.

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Temporal variation in rates of cesarean section for dystocia: Does “convenience” play a role?

Cited by 71 publications

References 6 publications

High caesarean rates in Madras (India): a population‐based cross sectional study

High caesarean rates in Madras (India): a population‐based cross sectional study

Economic Incentives in the Choice between Vaginal Delivery and Cesarean Section

Weekend hospitalization and mortality: a critical review

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