The labor-adjusted cesarean section rate—A more informative method than the cesarean section “rate” for assessing a practitioner's labor and delivery skills


      OBJECTIVE: Our purpose was to determine the benefits of an acuity-adjusted labor management tool. STUDY DESIGN: A retrospective review was performed of all deliveries at Good Samaritan Regional Medical Center in Phoenix, Arizona, for a 1-year period from Jan. 1 to Dec. 31, 1994. All physicians with ≥20 deliveries were included in the analysis. Patients with indications for which most practitioners would perform a cesarean delivery were removed from consideration. Physicians were then compared with respect to labor management in the remaining patients without relative contraindications to vaginal delivery. RESULTS: The total number of deliveries (n = 6062) was performed by 47 attending obstetricians, 9 perinatologists, an obstetrics-gynecology clinic, and a family practice clinic. The “raw” cesarean section rate was 20.1%. Those at high risk for cesarean delivery (n = 534) were excluded, leaving 684 cesarean sections performed in 5528 patients (12.4%) who were appropriate to labor. Differences were observed between the nulliparous cesarean section rate (16%) compared with that for parous patients (10.1%) (p < 0.0001 by Fisher's exact test (two-tailed) but not between attending obstetrician-gynecologists (12.4%) and perinatologists (13.8%) (not significant). CONCLUSION: A labor-adjusted cesarean section rate is more appropriate than just “raw” data. Medical, obstetric, and fetal factors affect a “raw” rate that is out of the control of the obstetrician. This method of assessing the labor and delivery skills of each practitioner and hospital would allow meaningful comparison with others. (Am J Obstet Gynecol 1997;177:139-43)


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        • U.S. Department of Health and Human Services
        Healthy people 2000: national health promotion and disease prevention objectives.
        Public Health Service, Washington1990
        • Taffel SM
        • Placek PJ
        • Liss T.
        Trends in the United States cesarean section rate and reasons for the 1980-85 rise.
        Am J Public Health. 1978; 77: 955-959
        • Taffel SM
        • Placek PJ
        • Moien M
        • Kosary CL.
        1989 U.S. cesarean section rate steadies—VBAC rate rises to nearly one in five.
        Birth. 1991; 18: 73-77
        • Philipson EH
        • Rosen MG.
        Trends in the frequency of cesarean births.
        Clin Obstet Gynecol. 1985; 28: 691-696
        • Baskett TF
        • McMillan RM.
        Cesarean section: trends and morbidity.
        Can Med Assoc J. 1981; 125: 723-726
        • Porreco RP.
        High cesarean section rate: a new perspective.
        Obstet Gynecol. 1985; 65: 307-311
        • Thorp JA
        • Parisi VM
        • Boylan PC
        • Johnston DA.
        The effect of continuous epidural analgesia on caesarean section for dystocia in nulliparous women.
        Am J Obstet Gynecol. 1989; 161: 670-675
        • Evard JR
        • Gold EM
        • Cahill TF.
        Cesarean section: a contemporary assessment.
        J Reprod Med. 1980; 24: 147-152
        • Sanchez-Ramos L
        • Farah LA
        • Kaunitz AM
        • Adair CD
        • Del Valle GO
        • Fuqua P.
        Preinduction cervical ripening with commercially available prostaglandin E2 gel: a randomized, double-blind comparison with a hospital-compounded preparation.
        Am J Obstet Gynecol. 1995; 173: 1979-1984
        • O'Driscoll F
        • Foley M
        • MacDonald D.
        Active management of labour as an alternative to caesarean section for dystocia.
        Obstet Gynecol. 1984; 63: 485-490
        • Miyazaki FJ
        • Nevarez F.
        Saline amnioinfusion for relief of repetitive variable decelerations: a prospective randomized study.
        Am J Obstet Gynecol. 1985; 153: 301-306
        • Nageotte MP
        • Freeman RK
        • Garite TJ
        • Dorchester W.
        Prophylactic intrapartum amnioinfusion in patients with preterm premature rupture of membranes.
        Am J Obstet Gynecol. 1985; 153: 557-563
        • Thacker SB
        • Stroup DF
        • Peterson HB.
        Efficacy and safety of intrapartum electronic fetal monitoring: an update.
        Obstet Gynecol. 1995; 86: 613-620
        • Gribble RK
        • Meier PR.
        Effect of epidural analgesia on the primary cesarean rate.
        Obstet Gynecol. 1991; 78: 231-234
        • Porreco RP.
        Meeting the challenge of the rising cesarean birth rate.
        Obstet Gynecol. 1990; 75: 133-136
        • Goyert GL
        • Bottoms SF
        • Treadwell MC
        • Nehra PC.
        The physician factor in cesarean birth rates.
        N Engl J Med. 1989; 320: 706-709