Obstetric interventions in two groups of hospitals in Catalonia: a cross-sectional study

Abstract

BackgroundChildbirth assistance in highly technological settings and existing variability in the interventions performed are cause for concern. In recent years, numerous recommendations have been made concerning the importance of the physiological process during birth. In Spain and Catalonia, work has been carried out to implement evidence-based practices for childbirth and to reduce unnecessary interventions.To identify obstetric intervention rates among all births, determine whether there are differences in interventions among full-term single births taking place in different hospitals according to type of funding and volume of births attended to, and to ascertain whether there is an association between caesarean section or instrumental birth rates and type of funding, the volume of births attended to and women’s age.MethodsCross-sectional study, taking the hospital as the unit of analysis, obstetric interventions as dependent variables, and type of funding, volume of births attended to and maternal age as explanatory variables. The analysis was performed in three phases considering all births reported in the MBDS Catalonia 2011 (7,8570 births), full-term single births and births coded as normal.ResultsThe overall caesarean section rate in Catalonia is 27.55% (CI 27.23 to 27.86). There is a significant difference in caesarean section rates between public and private hospitals in all strata. Both public and private hospitals with a lower volume of births have higher obstetric intervention rates than other hospitals (49.43%, CI 48.04 to 50.81).ConclusionsIn hospitals in Catalonia, both the type of funding and volume of births attended to have a significant effect on the incidence of caesarean section, and type of funding is associated with the use of instruments during delivery.

Practices and obstetric interventions in women from a state in the Northeast of Brazil

“…A Spanish study has shown that patients from the private health care system and private hospitals with fewer births are more likely to undergo cesarean section and invasive procedures such as episiotomy or instrumental vaginal delivery. 20 Another study evaluated the role played by the source of payment in increasing cesarean section rates in Brazil between 1998 and 2008 and showed that private payment was associated with higher cesarean rates, as well as an older age, greater length of formal education and residing outside the Northeast region. 21 A national survey carried out in Brazil in 2010 also showed a higher frequency of cesarean delivery among older women and those with greater lengths of formal education, primiparous, whose prenatal care was provided by the private health care system and residing in the South, Southeast and Midwest 22 regions.…”

Evaluation of quality improvement for cesarean sections programmes through mixed methods

“…Variations in the performance of CS and the factors influencing this disparity have become a major area of study in recent years [ 31 - 33 ] This research will range factors influencing care provision in both settings in order to reduce the disparities.…”

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

“…The analysis of 53770 births included for the years 2013 and 2014 revealed that the proportion of episiotomies performed was 22.9%, showing a reduction in relation to the analysis performed using the same methodology in 2007, which found a 29.2% ratio of episiotomies in singleton full-term vaginal non-instrumental births [2]. Data collected demonstrate that, in Catalonia, the systematic practice of performing episiotomies in this particular type of births has decreased and is now carried out more restrictively, as prescribed by practice-based evidence [9].…”

“…This work developed via three specific courses of action aimed at improving the infrastructure in maternity wards in hospitals, raising professionals' awareness and promoting women's participation in maternity care. All of these actions are coordinated by the Catalan Ministry of Health in order to involve all stakeholders and achieve greater consensus in promoting a model of normal childbirth care that is based on known recorded services the profile of the professional best practice.In 2013, a maternity care assessment was performed to explore obstetric interventions conducted on singleton, full-term deliveries in all hospitals in 2014 in Catalonia [2]. In our environment care provided at birth in women with normal pregnancy is assumed mostly by midwives, but the exact proportion of births attended by midwives is not known.…”

“…In 2013, a maternity care assessment was performed to explore obstetric interventions conducted on singleton, full-term deliveries in all hospitals in 2014 in Catalonia [2]. In our environment care provided at birth in women with normal pregnancy is assumed mostly by midwives, but the exact proportion of births attended by midwives is not known.…”