INFLUENCE OF AUDIT AND FEEDBACK ON USE OF CESAREAN-SECTION IN A GEOGRAPHICALLY-DEFINED POPULATION

The influence of audit and feedback on use of caesarean section was in vestigated in a geographically defined population. At the beginning of 1986 and throughout that year the three principal reasons for the inc reased use of caesarean section were drawn to the attention of the res ident obstetricians in the hospital where 85% of the women resident in the health district gave birth. A repeat survey of the indications fo r caesarean section was conducted for 1986 births. Despite an increase in the number of women delivered in 1986 who had previously had two o r more sections, the caesarean section rate fell from 15.9% in 1982 to 12.7% in 1986 (P < 0.005). Most of this decrease was due to a reducti on in caesarean section for the three indications that were the main c ontributors to the increased rate between 1974 and 1982. The rate for the women who gave birth in the hospital whose resident obstetricians had been informed about the preceding audit was 12.2%, compared with 1 5.6%, for the women who gave birth in other hospitals. Audit and feedb ack of specific information, imparted in a non-directive way to reside nt obstetricians responsible for performing caesarean section, probabl y accounted for a more rational use of caesarean section.