Cesarean Rates in England Vary Considerably

Variation remains after adjusting for maternal characteristics, particularly for emergency cases
By Monica Smith
HealthDay Reporter

THURSDAY, Oct. 7 (HealthDay News) -- An analysis of cesarean deliveries among different National Health Service (NHS) trusts in England found that, while maternal characteristics differ among the trusts, variation remains, even after adjusting for these characteristics. The researchers recommend examining issues linked to emergency procedures; their work was published Oct. 6 in BMJ.

Fiona Bragg, of the London School of Hygiene and Tropical Medicine, and colleagues analyzed hospital episode statistics from 146 English NHS trusts. A model was generated to estimate the chances of a woman having a cesarean section based on maternal characteristics and clinical risk factors to see whether those factors can explain the variation in unadjusted cesarean section rates among the trusts.

The researchers found that the unadjusted rates of cesarean section ranged from 13.6 to 31.9 percent among the trusts. Adjusted rates also varied considerably, from 14.9 to 32.1 percent, and variation between trusts was greater for emergency cases than for elective cesarean sections. Women were likelier to have a cesarean section if they'd had one previously (70.8 percent) or gave birth to a baby with breach presentation (89.8 percent). The authors write that, to reduce the variation in adjusted rates of cesarean section, issues linked to emergency procedures should be examined.

"NHS trusts, with the support of strategic health authorities and commissioners, need to examine the reasons for variation in cesarean section in their regions and how the consistency of care for pregnant women can be improved," the authors conclude.

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