DECREASING THE CESAREAN-SECTION RATE IN A PRIVATE HOSPITAL - SUCCESS WITHOUT MANDATED CLINICAL CHANGES

OBJECTIVE: We analyzed the delivery statistics from our institution to describe a successful program of cesarean section delivery reduction and to help us understand what factors explained the reduction. STUDY DESIGN: A retrospective analysis of various cesarean section rates and risk factors from a prospectively collected delivery database of all patients delivered between May 15, 1988, and June 30, 1994. During the study period we instituted a program of increasing awareness, confide ntial provider feedback, more aggressive laboring techniques, and othe r clinical guidelines. The delivery data were divided into 6-month int ervals and analyzed by chi(2) tables. RESULTS: The overall cesarean se ction rate fell from 31.1% to 15.4%. Similar reductions were noted in the primary (17.9% to 9.8%) and repeat cesarean section rates (13.2% t o 5.7%). The primary cesarean section rate fall was accompanied by a d rop in abdominal delivery for cephalopelvic disproportion and fetal di stress. The repeat cesarean section rate is explained by a significant increase in trial and successful vaginal birth after cesarean deliver y. No increase in maternal, fetal, or neonatal morbidity or mortality was observed. CONCLUSIONS: We have demonstrated that the cesarean deli very rate can be safely lowered in a private hospital without mandated clinical changes. Our data suggest that careful and detailed feedback can lead to improved clinical practice.