The impact of mandated in-hospital coverage on primary cesarian delivery rates in a large nonuniversity teaching hospital

Article Abstract:

Whether or not the attending obstetrician is in-hospital during the patient's labor may affect the cesarean rate. The year before Lehigh Valley Hospital, a teaching hospital, instituted in-hospital teaching attending physician coverage, the primary (first time) cesarean rate was 17.6%. During the first year of mandated in-house coverage, it dropped to 15.3%. It was 13.4% when the physician was on call in the hospital but 17.5% when the doctor was on call but not in the hospital. Among the 14 physicians for whom sufficient data were available, 4 had primary cesarean rates that were unchanged from both the previous year and by whether they were in-hospital. Among the other 10, the primary cesarean rate dropped from 19.6% to 12.5%. Most of the fall in rate was due to fewer cesareans for prolonged labor. No differences were found in neonatal outcomes. The primary cesarean rate among residents was unchanged from the previous year, remaining at 10.9%.

Officials and employees, Residents (Medicine), Hospitals, Gynecologic and obstetric, Gynecologic and obstetric hospitals

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Impact of a nurses' strike on the cesarian birth rate

Article Abstract:

A month-long nursing strike led to a reduction in cesarean rate. During a January, 1991 nurses' strike in Manitoba, Canada, hospital obstetric services operated with nursing staff at about 30% of normal. The cesarean section rate in the 16-month interval preceding the strike was 14.6%, dropping to 12.5% during the strike, and then returning to 13.7% after the strike was over. Reductions in cesarean rate occurred mostly among women with breech babies and women with a prior cesarean section. Cesareans for these indications accounted for 33% and 55% of the drop, respectively. In addition, fewer inductions of labor, epidurals, and general anesthesias were performed. Overall, newborn morbidity as measured by neonatal intensive care admissions, 5-minute Apgar scores less than 7, stillbirths, trauma, and readmission to the hospital within 30 days rose slightly. This may or may not be due to other factors than reduced nursing staff.

Nurses, Labor relations

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The cesarian birth epidemic: trends, causes, and solutions

Article Abstract:

It is not unrealistic to expect a further lowering of the cesarean birth rate to 15% in the next century. Cesarean birth rates climbed from 5.5% in 1970 to 24.7% in 1988 and have since fallen modestly to 22.8% in 1993. Factors found to affect the cesarean birth rate include the frequent use of epidural anesthesia for first-time mothers, breech positioning, type of medical insurance, and the changing profile of first-time mothers. Changing the management of active labor, educating the medical and insurance industries, and reforming the legal system may help lower the cesarean birth rates.

Obstetrics

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