Advocacy, Research

High primary cesarean rates are a multi-factorial problem



The question is, what are these local drivers?

We do have evidence of local practice patterns driving medical decisions, and our cesarean study shows variations in induction rates and delivery during weekdays. But, as the cesarean study points out, medical practice is not the only thing which varies by location.

Hospital location was also associated with rates of pre-pregnancy obesity and other medical conditions.  We know womens’ overall health varies by community. Factors such as poverty, air quality, and access to food and safe exercise mean some communities are simply more difficult places to be healthy.

Hospital location was associated with proportion of ethnic subgroups. In public health the assumption is ethnic subgroups may be proxies for cultural group-specific priorities in medical decision making. In the cesarean study, the contribution of “ethnicity” was up to up to 15% of the variation – while the effect was always there, the impact of it changed in different regions.

What does all this mean?

Can I suggest this means high cesarean rates are a multi-factorial problem. There is no single cause, and therefore no single “problem” which can be fixed to lower the rate.

Yes, improvements in evidence-based medical decision making are needed.  But so are improvements in other drivers of community health; and changes in women’s medical decision making; and probably other things which we haven’t discussed in this post.

So think about your community. Are all these areas being addressed?  If so, how? If not, why?

Jennifer Vanderlaan (Author)