Estimating the proportion of unnecessary Cesarean sections in Ohio using birth certificate data

The main objective of the study is to present a method that estimates the p roportion of unnecessary Cesarean sections (C-sections) using birth certifi cate data. This population-based cross-sectional study uses two major datab ases-Ohio birth certificates and Medicaid eligibility files-and includes si ngleton infants born during the period July 1991 through June 1993 (n = 262 ,013). A total of 57 variables indicative of adverse events, including mate rnal medical risk factors, complications of labor and delivery, and congeni tal anomalies that are available on the birth certificate, are examined to estimate the rate of unnecessary C-sections. The results obtained through t his method indicate that nearly 40% of the repeat C-sections had no documen ted abnormalities on the birth certificate to justify a C-section. Because studies using medical records have yielded similar results, we believe that using birth certificate data may be a reliable method to measure and monit or the rate of unnecessary C-sections, J CLIN EPIDEMIOL 51;12:1327-1334, 19 98. (C) 1998 Elsevier Science Inc.