FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 319:1511-1516 December 8, 1988 Number 23 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

Despite the consensus that national cesarean-section rates are excessive, they continue to rise. Currently, approximately one of every four deliveries is by cesarean section. We developed an initiative to reduce the number of cesarean deliveries to a rate of 11 percent of all deliveries at our inner-city hospital. Participation by attending physicians was voluntary and not linked to any sanction. The program included a stringent requirement for a second opinion, objective criteria for the four most common indications for cesarean section, and a detailed review of all cesarean sections and of individual physicians' rates of performing them. During the first two years of the program, the cesarean-section rate fell from 17.5 percent of 1697 deliveries in 1985 to 11.5 percent of 2301 deliveries in 1987 (P less than 0.05). The proportion of infants with five-minute Apgar scores lower than 7 increased from 3 percent in 1985 to 4.9 percent in 1987 (P less than 0.05), but neither the fetal mortality rate (11.9 per 1000) nor the neonatal mortality rate (11.2 per 1000) in 1987 differed significantly from the rates in 1985. A single maternal death, unrelated to cesarean delivery, occurred during the study. Rates of both primary and repeat cesarean sections decreased, although only the decline in the rate of primary cesarean sections, from 12 to 6.8 percent, was statistically significant (P less than 0.05). During the same period, operative vaginal deliveries (i.e., forceps deliveries and midpelvic procedures) declined from 10.4 to 4.3 percent (P less than 0.05) of total deliveries. We conclude that an initiative within an obstetrics department can reduce cesarean-section rates substantially without adverse effects on the outcome for mother or infant.

Source Information

Department of Obstetrics and Gynecology, Mount Sinai Hospital Medical Center, Chicago, IL 60608.

This article has been cited by other articles:

• Fischer, A., LaCoursiere, D. Y., Barnard, P., Bloebaum, L., Varner, M. (2005). Differences Between Hospitals in Cesarean Rates for Term Primigravidas With Cephalic Presentation. Obstet Gynecol 105: 816-821 [Abstract] [Full Text]  
• Suwanrath-Kengpol, C., Pinjaroen, S., Krisanapan, O., Petmanee, P. (2004). Effect of a clinical practice guideline on physician compliance. Int J Qual Health Care 16: 327-332 [Abstract] [Full Text]  
• Li, T., Rhoads, G. G., Smulian, J., Demissie, K., Wartenberg, D., Kruse, L. (2003). Physician Cesarean Delivery Rates and Risk-Adjusted Perinatal Outcomes. Obstet Gynecol 101: 1204-1212 [Abstract] [Full Text]  
• Peaceman, A. M., Feinglass, J., Manheim, L. M. (2002). Risk-Adjustment of Cesarean Delivery Rates: A Practical Method for Use in Quality Improvement. American Journal of Medical Quality 17: 113-117 [Abstract]  
• Lydon-Rochelle, M., Holt, V. L., Martin, D. P., Easterling, T. R. (2000). Association Between Method of Delivery and Maternal Rehospitalization. JAMA 283: 2411-2416 [Abstract] [Full Text]  
• Beilin, Y., Leibowitz, A. B., Bernstein, H. H., Abramovitz, S. E. (1999). Controversies of Labor Epidural Analgesia. Anesth. Analg. 89: 969-969 [Full Text]  
• ROUSE, D. J., OWEN, J., HAUTH, J. C. (1999). Active-Phase Labor Arrest: Oxytocin Augmentation for at Least 4 Hours. Obstet Gynecol 93: 323-328 [Abstract] [Full Text]  
• Sachs, B. P., Kobelin, C., Castro, M. A., Frigoletto, F. (1999). The Risks of Lowering the Cesarean-Delivery Rate. NEJM 340: 54-57 [Full Text]  
• Studnicki, J., Remmel, R., Campbell, R., Werner, D. C. (1997). The Impact of Legislatively Imposed Practice Guidelines on Cesarean Section Rates: The Florida Experience. American Journal of Medical Quality 12: 62-68 [Abstract]  
• Hasselblad, V., McCrory, D. C. (1995). Meta-analytic Tools for Medical Decision Making: A Practical Guide. Med Decis Making 15: 81-96 [Abstract]  
• Henriksen, T B, Bek, K M, Hedegaard, M, Secher, N J (1994). Methods and consequences of changes in use of episiotomy. BMJ 309: 1255-1258 [Abstract] [Full Text]  
• Chilingerian, J. A., Glavin, M. P. V. (1994). Temporary Firms in Community Hospitals: Elements of a Managerial Theory of Clinical Efficiency. Med Care Res Rev 51: 289-335  
• (1988). LOWERING C-SECTION RATES. JWatch General 1988: 9-9 [Full Text]