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

Abstract

The rates of cesarean section, maternal complications and neonatal asphyxia vary markedly between different delivery units. Good maternal and neonatal outcomes can be achieved with cesarean section rates <15%.

Variation in hospital caesarean section rates and obstetric outcomes among nulliparae at term: a population-based cohort study

“…In NSW between 2009 and 2010, 28.1% of nulliparous women with a singleton cephalic infant at term had a CS. Consistent with other studies, we found unexplained variation in hospital CS rates among nulliparous women at term after adjusting for differences in case‐mix. After adjusting for differences in case‐mix, labour and delivery, and hospital factors, for women who had a prelabour CS and those who had an intrapartum CS following spontaneous labour, variations in hospital CS rates were substantially reduced by 78 and 52%, respectively.…”

“…The appropriateness of any CS rate can only be interpreted if the attendant morbidity and mortality are known. Previous studies have found conflicting associations between overall case‐mix adjusted hospital CS rates and maternal and neonatal outcomes, with some studies finding that neonatal morbidity increased with both high and low case‐mix adjusted CS rates and others finding no association between neonatal morbidity and case‐mix adjusted CS rates . This may be due to the reporting of different neonatal outcomes (for example, 5‐min Apgar score <7 or neonatal asphyxia) for the overall case‐mix adjusted hospital CS rate.…”

“…In some developing countries where CS rates are low, the lack of CS is associated with major maternal and neonatal mortality and morbidity, and so an increase in the CS rate in these countries is likely to be beneficial to pregnancy outcomes. In contrast, in developed countries, recent high and current variations in CS rates have not been shown to be associated with improvements in maternal or neonatal physical outcomes …”

Hospital variation in cost of childbirth and contributing factors: a cross‐sectional study

“…This is consistent with findings from other studies in the USA and European countries showing no benefit of excessive obstetric interventions (e.g. caesarean delivery) in improving maternal or perinatal outcomes . The American College of Obstetricians and Gynecologists also highlighted ‘limited or uncertain benefit’ of many common obstetric practices (e.g.…”

Case mix adjusted variation in cesarean section rate in Sweden

“…Differences in case mix have been suggested as a potential reason for these variations. Case‐mix‐adjusted variations in CS rate for a number of different countries have been presented but no such comparisons between hospitals in Sweden have previously been published. Furthermore, few previous studies have included both administrative data and medical record data as well as sociodemographic information in case mix adjustment.…”