Patterns of use of obstetrical interventions in 12 countries

Abstract

Recent obstetrical practice trends in 12 countries were surveyed. There was a 3-fold difference in caesarean section rates and a 10-fold difference in instrumental vaginal delivery rates among countries. There was a net increase in the caesarean section rate of all countries over the study period and a net decrease in the instrumental vaginal delivery rate of some countries. There was a decrease in the caesarean section rate during the last year of observation in Australia, Denmark and Finland. In general, countries with high caesarean rates also had high instrumental vaginal delivery rates. There was no consistent relationship between use of caesarean section and use of instrumental vaginal delivery, although in several countries increasing use of caesarean section was accompanied by decreasing use of instrumental vaginal delivery. Oxytocin use rates were associated positively with instrumental delivery but not with caesarean section rates. While it was not possible to determine the proportions of women who received appropriate obstetrical care, we can infer that a significant proportion of interventions were unnecessary or only marginally beneficial. Continued increases in rates of obstetrical intervention are unlikely to result in improvements in birth outcome overall and may pose a risk to mothers and their newborns.

How effective is amniotomy as a means of induction of labour?

“…We accept that the early employment of oxytocin use following amniotomy does decrease the labour onset to delivery interval [5]. It is acknowledged that the use of oxytocin impacts positively on instrumental delivery rates, but its use has yet to be standardised or impact significantly on caesarean section rates worldwide [6]. In our unit the use of oxytocin is confined to a delivery ward setting and is governed by the guidelines set down in the active management of labour policy [7].…”

Variation in rates of postterm birth in Europe: reality or artefact?

“…This interpretation is concordant with other studies that have documented marked differences in the management of pregnancy and delivery in Europe. [16][17][18][19] Before we reach this conclusion, however, we must consider to what extent differences in the measurement of gestational age explain the variability between countries. A large literature shows that the methods used to determine gestational age influence the postterm rate.…”

Incidência e duração da amamentação conforme o tipo de parto: estudo longitudinal no Sul do Brasil

“…Esse risco tem sido associado, dentre outros fatores, com o tipo de parto, particularmente com cesarianas 9,28 . A proporção de cesarianas varia marcadamente entre países 24 , regiões e subpopulações 2,14,30 . O rápi-do aumento de partos por cesariana ocorrido na dé-cada de 1970, na maioria dos países, deu lugar a uma desaceleração na década de 1980 25 .…”