Skip to main content
NCBI home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1993 Aug;83(8):1109–1112. doi: 10.2105/ajph.83.8.1109

Variation in cesarean section rates among hospitals in Washington State.

L McKenzie 1, P A Stephenson 1
PMCID: PMC1695162  PMID: 8342718

Abstract

OBJECTIVES. This study examined hospital characteristics and hospital population risk factors and their associations with hospital-specific cesarean section rates in Washington State. METHODS. Data were obtained from 1987 birth certificates. The study population included all hospitals that had 12 or more singleton live births. RESULTS. Hospital-specific cesarean section rates varied from 0% to 43% and were positively associated with proprietary ownership, size of delivery service, and the proportions of women who had complications or high-birthweight infants. The proportion of women who had late prenatal care was inversely associated with cesarean section rates. Although proprietary hospitals had higher cesarean section rates, their patient populations were lower risk than patients of public or teaching hospitals. CONCLUSIONS. Variation in cesarean section rates among hospitals cannot be fully explained by either hospital or patient population characteristics. A combined strategy may be necessary to lower unjustifiably high cesarean section rates.

Full text

PDF
1109

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acker D. B., Haas S., O'Brien E., Donahue C. L., Jr, Porell M. M., Sachs B. P. Cesarean birth rate: small-geographic-area analysis. Am J Obstet Gynecol. 1988 Aug;159(2):386–388. doi: 10.1016/s0002-9378(88)80090-5. [DOI] [PubMed] [Google Scholar]
  2. Fraser W., Usher R. H., McLean F. H., Bossenberry C., Thomson M. E., Kramer M. S., Smith L. P., Power H. Temporal variation in rates of cesarean section for dystocia: does "convenience" play a role? Am J Obstet Gynecol. 1987 Feb;156(2):300–304. doi: 10.1016/0002-9378(87)90272-9. [DOI] [PubMed] [Google Scholar]
  3. Gold R. B., Kenney A. M. Paying for maternity care. Fam Plann Perspect. 1985 May-Jun;17(3):103–111. [PubMed] [Google Scholar]
  4. Gould J. B., Davey B., Stafford R. S. Socioeconomic differences in rates of cesarean section. N Engl J Med. 1989 Jul 27;321(4):233–239. doi: 10.1056/NEJM198907273210406. [DOI] [PubMed] [Google Scholar]
  5. Goyert G. L., Bottoms S. F., Treadwell M. C., Nehra P. C. The physician factor in cesarean birth rates. N Engl J Med. 1989 Mar 16;320(11):706–709. doi: 10.1056/NEJM198903163201106. [DOI] [PubMed] [Google Scholar]
  6. Horton J. A., Cruess D. F., Korper M. Deliveries in U.S. military and non-federal hospitals, 1980. Mil Med. 1988 Dec;153(12):611–614. [PubMed] [Google Scholar]
  7. Krikke E. H., Bell N. R. Relation of family physician or specialist care to obstetric interventions and outcomes in patients at low risk: a western Canadian cohort study. CMAJ. 1989 Mar 15;140(6):637–643. [PMC free article] [PubMed] [Google Scholar]
  8. Lomas J., Anderson G. M., Domnick-Pierre K., Vayda E., Enkin M. W., Hannah W. J. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med. 1989 Nov 9;321(19):1306–1311. doi: 10.1056/NEJM198911093211906. [DOI] [PubMed] [Google Scholar]
  9. Newton E. R., Higgins C. S. Factors associated with hospital-specific cesarean birth rates. J Reprod Med. 1989 Jun;34(6):407–411. [PubMed] [Google Scholar]
  10. Petitti D. B. Recent trends in cesarean delivery rates in California. Birth. 1985 Spring;12(1):25–28. doi: 10.1111/j.1523-536x.1985.tb00926.x. [DOI] [PubMed] [Google Scholar]
  11. Placek P. J., Taffel S. M. Recent patterns in cesarean delivery in the United States. Obstet Gynecol Clin North Am. 1988 Dec;15(4):607–627. [PubMed] [Google Scholar]
  12. Porreco R. P. Meeting the challenge of the rising cesarean birth rate. Obstet Gynecol. 1990 Jan;75(1):133–136. [PubMed] [Google Scholar]
  13. Reid A. J., Carroll J. C., Ruderman J., Murray M. A. Differences in intrapartum obstetric care provided to women at low risk by family physicians and obstetricians. CMAJ. 1989 Mar 15;140(6):625–633. [PMC free article] [PubMed] [Google Scholar]
  14. Stafford R. S. Alternative strategies for controlling rising cesarean section rates. JAMA. 1990 Feb 2;263(5):683–687. [PubMed] [Google Scholar]
  15. Stafford R. S. Cesarean section use and source of payment: an analysis of California hospital discharge abstracts. Am J Public Health. 1990 Mar;80(3):313–315. doi: 10.2105/ajph.80.3.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Williams R. L., Chen P. M. Controlling the rise in cesarean section rates by the dissemination of information from vital records. Am J Public Health. 1983 Aug;73(8):863–867. doi: 10.2105/ajph.73.8.863. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Williams R. L., Hawes W. E. Cesarean section, fetal monitoring, and perinatal mortality in California. Am J Public Health. 1979 Sep;69(9):864–870. doi: 10.2105/ajph.69.9.864. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. de Regt R. H., Minkoff H. L., Feldman J., Schwarz R. H. Relation of private or clinic care to the cesarean birth rate. N Engl J Med. 1986 Sep 4;315(10):619–624. doi: 10.1056/NEJM198609043151005. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES