REGIONAL DIFFERENCES IN OPERATIVE OBSTETRICS - A LOOK TO THE SOUTH

Objective: To compare operative delivery rates across regions of the U nited States from 1987 to 1994 and to evaluate how the rates of severe obstetric lacerations changed during the same period. Methods: I used diagnosis and procedure data from the National Hospital Discharge Sur vey and natality data from the National Center for Health Statistics t o describe temporal and regional variations in the rates of cesarean, forceps, and vacuum delivery. I described temporal trends in the rates of cervical and severe perineal lacerations during the same period. I performed exploratory analyses of detailed 1990 data to test for regi onal differences in demographic risk factors that might explain differ ences in operative delivery rates. Results: Between 1987 and 1994, ces arean delivery rates fell from approximately 25% to less than 22% in a ll regions except the South. Operative vaginal delivery rates were sta ble at 10-12% and were consistently lowest in the Northeast (8.2% in 1 994) and highest in the South (12.9% in 1994). Vacuum surpassed forcep s deliveries in all regions except the South. The rates of cervical an d fourth-degree perineal lacerations declined by 57% and 40%, respecti vely, whereas the rate of third-degree lacerations did not decline. De mographic risk factors for cesarean delivery were no more prevalent in the South than in other regions. Age under 25 years was the only demo graphic risk factor for forceps delivery that was more prevalent in th e South. Conclusion: In all but the southern United States, cesarean d elivery rates declined and vacuum surpassed forceps delivery. These re gional differences are not explained by differences in demographic ris k factors. (Obstet Gynecol 1998;92: 514-9. (C) 1995 by The American Co llege of Obstetricians and Gynecologists.).