EFFECT OF DEPARTMENTAL POLICIES ON CESAREAN DELIVERY RATES - A COMMUNITY-HOSPITAL EXPERIENCE

Objective: During 1994, our department adopted several strategies in a n attempt to decrease our cesarean delivery rates. This study evaluate s the effect of these changes on our cesarean delivery rates. Methods: We studied data of women who delivered at our community hospital obst etric unit over a period of 6 years, from January 1, 1991, to December 31, 1996. During 1994, our department adopted labor management and ce sarean delivery guidelines, with review of every cesarean delivery tha t did not meet guidelines and confidential individual feedback; establ ished 24-hour in-house coverage; and attempted to achieve the goal of an annual cesarean delivery rate of less than 15%. These data were eva luated by chi(2) analysis. Women who delivered in the first 3 years (g roup A) were compared with those who delivered in the second 3 years ( group B) (ie, when the changes occurred). P < .05 was considered signi ficant. Results: Groups A and B shared similar demographic characteris tics. The total cesarean delivery rate decreased from 22.5% (group A) to 18.6% (group B) (P = .001), whereas the primary cesarean delivery r ate decreased from 13.5% to 10.6% (P = .001) and the repeat cesarean d elivery rate decreased from 9.0% to 7.9% (P = .03). The proportion of women who received oxytocin and regional anesthesia and underwent vacu um-assisted deliveries increased (P < .001), whereas perinatal mortali ty and morbidity did not change. Conclusion: The cesarean delivery rat e safely decreased. These data suggest the importance of the commitmen t of attending physicians to a lower cesarean delivery rate, of servic e improvements, and of detailed feedback. (C) 1998 by The American Col lege of Obstetricians and Gynecologists.