Hospital primary cesarean delivery rates and the risk of poor neonatal outcomes

Objective: The purpose of this study was to determine whether risk-adjusted hospital primary cesarean delivery rates are associated with poor neonatal outcomes. Study Design: The Washington State Birth Events Records for 1995 and 1996 were used. Predicted primary cesarean delivery rates were calculated for each hospital. Women were divided by whether the hospital had an actual primary cesarean delivery rate below, within, or greater than the predicted CI. Asphyxia (a lack of oxygen that leads to organ damage) was used as a marker of poor neonatal outcome. Risk of neonatal asphyxia was compared for each of the 3 cesarean rating groups. Results: The risk for asphyxia among infants who were born to women who delivered at hospitals that had more, within, or fewer cesarean deliveries than predicted were 0.58%, 0.17%, and 0.33%, respectively (P< .0001). Conclusion: Infants born to women who delivered at hospitals that had more than or fewer than the predicted number of primary cesarean deliveries experienced a greater risk of neonatal asphyxia. (Am J Obstet Gynecol 2002;187:721-7.)