STUDY OF THE VARIATIONS OF THE CESAREAN-SECTIONS RATE IN THE RHONE-ALPES REGION (FRANCE) - EFFECT OF WOMEN AND MATERNITY SERVICE CHARACTERISTICS

Objective: To analyze the variations of the rate of prophylactic cesar ean sections and cesarean sections during labor according to the women 's and maternity services' characteristics. Study Design: The study po pulation was a sample of 8 470 women having delivered in one of the 86 maternity services of the Rhone-Alpes region (France) in 1990. The wo men's characteristics were risk factors for pregnancy or delivery. The maternity services' characteristics included those describing the ser vice structure and the mode of recruitment. For the statistical analys is we used a two-level logistic model. Results: After taking into acco unt the women's characteristics, there remained a variation between th e maternity services. This variation was in part explained by the type of recruitment of the maternity service. When the proportion of women with a previous cesarean section or a dystocia increased in the mater nity service the cesarean sections rate decreased in women presenting similar characteristics. Conclusion: Thus, the maternity services whic h receive many ''at risk'' women tend to have higher cesarean section rates than the others. However, in comparison with women presenting si milar characteristics, these same maternity services tend to perform f ewer cesarean sections. (C) 1998 Elsevier Science Ireland Ltd.