Quality of obstetric care and risk-adjusted primary cesarean delivery rates

Objective The purpose of this study was to examine the association between risk-adjusted primary cesarean delivery rates and maternal and neonatal outcomes. Study design California birth certificate data that were linked to hospital discharge data for 2001 were used to create a primary cesarean delivery rate risk-adjustment model. Two hundred eighty-five hospitals were divided into 3 groups that were above, below, or within expected rate confidence intervals. Maternal and neonatal outcomes were compared within each of the 3 hospital groupings. Results Of the 285 hospitals, 27% had primary cesarean delivery rates that were above expected confidence intervals; 34% had primary cesarean delivery rates that were below expected confidence intervals, and 39% had primary cesarean delivery rates that were within expected confidence intervals. Neonatal asphyxia rates were higher in hospitals that had lower than expected rates of cesarean deliveries (0.05%, 0.1%, 0.07% for above, below, and within the confidence intervals, respectively; P< .0001). Maternal infection rates (2.1%, 2.3%, 1.8%, respectively; P< .0001) and third-degree tears (2.3%, 3.0%, 2.6%, respectively; P< .0001) were also higher in hospitals for which the cesarean delivery rates were above or below the expected rates. Conclusion Risk-adjusted primary cesarean delivery rates are a good marker for maternal and neonatal outcomes.