Differences Among Obstetricians in Caesarean Section Rates

Abstract

This retrospective study examined the Caesarean section rates of 15 obstetricians at 1 hospital delivering 5,559 nulliparas with a single cephalic baby of birth-weight > or = 2,500 g. There was a wide variation in obstetricians' Caesarean rates, whether considering all their deliveries (5.5% to 20.1%), deliveries of their own patients (8.9% to 28.2%), or deliveries of their colleagues' patients (4.5% to 17.9%). There was no relation between Caesarean rates and perinatal outcome. The different Caesarean section rates among the obstetricians could not be explained by institutional factors, physician convenience, patient differences, or self-serving economic incentives.

Do Urgent Caesarean Sections Have a Circadian Rhythm?

“…The variability of urgent caesarean sections may strongly be associated with biological Figure 1. The distribution of caesarean sections during the day and night shifts factors such as onset time and length of delivery, along with medical decisions and convenience (10,12). To the current knowledge, it is well described that elective induction of labour clearly results in an increased rate of operative vaginal birth or caesarean section (13,14).…”

“…In a scientific base, emergency in deliveries should follow a circadian route, which should not be impaired by environmental factors. However, the definition of 'emergency' may be altered by temporal variations or the availability of the emergency team (11,12). Therefore, the aim of the present study was to elucidate the existence of a possible circadian variation in urgent operative deliveries.…”

Perinatal outcomes for Bella Coola General Hospital: 1940 to 2001.

“…From 1989 to 1994, Canada had the second highest cesarean rate in the Western developed world (Menticoglou, 1997). The increase in cesareans is thought to be related to technologic advances, increase in the age o f childbearing, and tbe belief in its safety for both the mother and the fetus, however, perinatal mortality has been declining for decades and incidence o f long-term neurological defects has not been conclusively demonstrated with its use (Mindell, Vayda, & Cardillo, 1982).…”

“…These studies show the Americas as having the highest cesarean section rates in the world compared to their European and Asian eounterparts. Among developed countries, the US and Canada have relatively high cesarean section rates (19 to 23%) (Menticoglou, 1997 and Japan report relatively low rates o f cesarean sections (5 to 10%) (Klein, 1988;Notzon, 1990).…”

“…In China, county hospitals had rates o f 30%, whereas district hospitals had rates o f 73% (Qiân, et al, 2001). Such worldwide differences in rates indicates cesareans are not related as much to maternal or fetal factors as much as cultural, technological, geographical and social factors (Klein, 1988;Menticoglou, 1997;& Wagner, 2000).…”