Reducing cesarean births at a primarily private university hospital

Michael L Socol*, Patricia M Garcia, Alan M Peaceman, Sharon L Dooley

*Corresponding author for this work

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

OBJECTIVES: The rise in cesarean birth at Northwestern Memorial Hospital in 1986 to 27.3% prompted implementation of three initiatives to reverse the escalating cesarean section rate. STUDY DESIGN: First, vaginal birth after cesarean section was more strongly encouraged. Second, after the 1988 calendar year the cesarean section rate of every obstetrician was circulated annually to each attending physician. Third, on completion of a prospective, randomized trial of the active management of labor in early 1991, this protocol was recommended as the preferred method of labor management for term nulliparous patients. RESULTS: The total, primary, and repeat cesarean section rates declined from 27.3%, 18.2%, and 9.1% in 1986 to 16.9%, 10.6%, and 6.4%, respectively, in 1991. At the same time the perinatal mortality dropped from 19.5 to 10.3. Significant reductions in abdominal deliveries occurred for both private patients (30.3% to 19.1%, p < 0.0001) and clinic patients (20.8% to 11.5%, p < 0.0001). A decline in operative deliveries for dystocia and an increase in vaginal birth after prior cesarean section were the principal factors contributing to the lower cesarean section rates. However, in 1991 individual private physicians still had wide variations in primary cesarean section rates (4.6% to 21.1%) and use of vaginal birth after prior cesarean section (5.3% to 90%). CONCLUSION: The cesarean section rate has been significantly reduced for both private and clinic patients. Differences in population demographics and individual physician practice patterns contributed to a higher incidence of cesarean birth on the private service.

Original languageEnglish (US)
Pages (from-to)1748-1758
Number of pages11
JournalAmerican journal of obstetrics and gynecology
Volume168
Issue number6 PART 1
DOIs
StatePublished - Jan 1 1993

Fingerprint

Private Hospitals
Cesarean Section
Parturition
Vaginal Birth after Cesarean
Repeat Cesarean Section
Physicians' Practice Patterns
Physicians
Dystocia
Birth Order
Perinatal Mortality
Demography
Incidence

Keywords

  • Cesarean section
  • active management of labor
  • dystocia
  • vaginal birth after cesarean section

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

@article{633805ed6a00456c9b6624b2a3a3958e,
title = "Reducing cesarean births at a primarily private university hospital",
abstract = "OBJECTIVES: The rise in cesarean birth at Northwestern Memorial Hospital in 1986 to 27.3{\%} prompted implementation of three initiatives to reverse the escalating cesarean section rate. STUDY DESIGN: First, vaginal birth after cesarean section was more strongly encouraged. Second, after the 1988 calendar year the cesarean section rate of every obstetrician was circulated annually to each attending physician. Third, on completion of a prospective, randomized trial of the active management of labor in early 1991, this protocol was recommended as the preferred method of labor management for term nulliparous patients. RESULTS: The total, primary, and repeat cesarean section rates declined from 27.3{\%}, 18.2{\%}, and 9.1{\%} in 1986 to 16.9{\%}, 10.6{\%}, and 6.4{\%}, respectively, in 1991. At the same time the perinatal mortality dropped from 19.5 to 10.3. Significant reductions in abdominal deliveries occurred for both private patients (30.3{\%} to 19.1{\%}, p < 0.0001) and clinic patients (20.8{\%} to 11.5{\%}, p < 0.0001). A decline in operative deliveries for dystocia and an increase in vaginal birth after prior cesarean section were the principal factors contributing to the lower cesarean section rates. However, in 1991 individual private physicians still had wide variations in primary cesarean section rates (4.6{\%} to 21.1{\%}) and use of vaginal birth after prior cesarean section (5.3{\%} to 90{\%}). CONCLUSION: The cesarean section rate has been significantly reduced for both private and clinic patients. Differences in population demographics and individual physician practice patterns contributed to a higher incidence of cesarean birth on the private service.",
keywords = "Cesarean section, active management of labor, dystocia, vaginal birth after cesarean section",
author = "Socol, {Michael L} and Garcia, {Patricia M} and Peaceman, {Alan M} and Dooley, {Sharon L}",
year = "1993",
month = "1",
day = "1",
doi = "10.1016/0002-9378(93)90686-D",
language = "English (US)",
volume = "168",
pages = "1748--1758",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "6 PART 1",

}

TY - JOUR

T1 - Reducing cesarean births at a primarily private university hospital

AU - Socol, Michael L

AU - Garcia, Patricia M

AU - Peaceman, Alan M

AU - Dooley, Sharon L

PY - 1993/1/1

Y1 - 1993/1/1

N2 - OBJECTIVES: The rise in cesarean birth at Northwestern Memorial Hospital in 1986 to 27.3% prompted implementation of three initiatives to reverse the escalating cesarean section rate. STUDY DESIGN: First, vaginal birth after cesarean section was more strongly encouraged. Second, after the 1988 calendar year the cesarean section rate of every obstetrician was circulated annually to each attending physician. Third, on completion of a prospective, randomized trial of the active management of labor in early 1991, this protocol was recommended as the preferred method of labor management for term nulliparous patients. RESULTS: The total, primary, and repeat cesarean section rates declined from 27.3%, 18.2%, and 9.1% in 1986 to 16.9%, 10.6%, and 6.4%, respectively, in 1991. At the same time the perinatal mortality dropped from 19.5 to 10.3. Significant reductions in abdominal deliveries occurred for both private patients (30.3% to 19.1%, p < 0.0001) and clinic patients (20.8% to 11.5%, p < 0.0001). A decline in operative deliveries for dystocia and an increase in vaginal birth after prior cesarean section were the principal factors contributing to the lower cesarean section rates. However, in 1991 individual private physicians still had wide variations in primary cesarean section rates (4.6% to 21.1%) and use of vaginal birth after prior cesarean section (5.3% to 90%). CONCLUSION: The cesarean section rate has been significantly reduced for both private and clinic patients. Differences in population demographics and individual physician practice patterns contributed to a higher incidence of cesarean birth on the private service.

AB - OBJECTIVES: The rise in cesarean birth at Northwestern Memorial Hospital in 1986 to 27.3% prompted implementation of three initiatives to reverse the escalating cesarean section rate. STUDY DESIGN: First, vaginal birth after cesarean section was more strongly encouraged. Second, after the 1988 calendar year the cesarean section rate of every obstetrician was circulated annually to each attending physician. Third, on completion of a prospective, randomized trial of the active management of labor in early 1991, this protocol was recommended as the preferred method of labor management for term nulliparous patients. RESULTS: The total, primary, and repeat cesarean section rates declined from 27.3%, 18.2%, and 9.1% in 1986 to 16.9%, 10.6%, and 6.4%, respectively, in 1991. At the same time the perinatal mortality dropped from 19.5 to 10.3. Significant reductions in abdominal deliveries occurred for both private patients (30.3% to 19.1%, p < 0.0001) and clinic patients (20.8% to 11.5%, p < 0.0001). A decline in operative deliveries for dystocia and an increase in vaginal birth after prior cesarean section were the principal factors contributing to the lower cesarean section rates. However, in 1991 individual private physicians still had wide variations in primary cesarean section rates (4.6% to 21.1%) and use of vaginal birth after prior cesarean section (5.3% to 90%). CONCLUSION: The cesarean section rate has been significantly reduced for both private and clinic patients. Differences in population demographics and individual physician practice patterns contributed to a higher incidence of cesarean birth on the private service.

KW - Cesarean section

KW - active management of labor

KW - dystocia

KW - vaginal birth after cesarean section

UR - http://www.scopus.com/inward/record.url?scp=0027286729&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027286729&partnerID=8YFLogxK

U2 - 10.1016/0002-9378(93)90686-D

DO - 10.1016/0002-9378(93)90686-D

M3 - Article

VL - 168

SP - 1748

EP - 1758

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 6 PART 1

ER -