Study of the variations of the cesarean sections rate in the Rhône–Alpes region (France): Effect of women and maternity service characteristics

Estimation of an expected caesarean section rate taking into account the case mix of a maternity hospital. Analysis from the AUDIPOG Sentinelle Network (France)

“…Concerning the characteristics of the maternity units, we showed the role of levels of care, juridical status and size of the maternity unit in the caesarean section rate. These observations had already been noted by different authors 15,18,33 . We noted the important effect of the juridical status: private maternity units with fewer than 1500 deliveries/year performed significantly more caesarean sections, before and during labour, than university maternity units with more than 2000 deliveries.…”

“…After introduction of all characteristics in the multilevel model, we found unit effect of maternity units significantly associated with caesarean section risk. With the same statistical method, Rabilloud et al 18 also demonstrated a significant residual variation from one maternity unit to another. This unit effect of maternity unit could be compared with what is described by other authors as physician effect 14–17,32 .…”

“…In England, Rosenberg et al 11 attempted to explain the reasons for an increase in the caesarean section rate from 1971 to 1982 with possible modifications of caesarean section indications. However, many authors have shown that the caesarean section rate did not only depend on the women's characteristics but also on the hospital or the obstetricians’ characteristics 12–18 . Anderson et al 12 identified a constant increase in the caesarean section rate from 1979 to 1982 while the incidence of main indications for caesarean section remained stable.…”

“…In 1989, in a hospital in Michigan, USA, Applegate et al 17 showed that in a population of low risk women, family physicians carried out almost fourfold fewer caesarean sections than obstetricians for the same perinatal results. In the Rhône‐Alpes area (France), Rabilloud et al 18 showed that, for the same women, the delivery method could vary from one maternity unit to another.…”

Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea

“…After a review of previous studies [5,[23][24][25][26][27][28][29][30] that identified the risk factors for CS, 16 factors identified in claims were selected: malpresentation, eclampsia, malignancy, problems in placenta, previous CS, age, bleeding, diabetes, dysfunctional labor, fetal distress, cord prolapse, fetal abnormality, polyhydramnios/oligohydramnios, premature rupture of membranes, preterm delivery, and anogenital herpes.…”