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. 2007 Jun;196(6):526.e1-5.
doi: 10.1016/j.ajog.2007.01.024.

Variation in the rates of operative delivery in the United States

Steven L Clark  1 , Michael A Belfort, Gary D V Hankins, Janet A Meyers, Frank M Houser
Affiliations

Variation in the rates of operative delivery in the United States

Steven L Clark et al. Am J Obstet Gynecol. 2007 Jun.

Abstract

Objectives: This study was undertaken to examine the national and regional rates of operative delivery among almost one quarter million births in a single year in the nation's largest healthcare delivery system, using variation as an arbiter of the quality of decision making.

Study design: We compared the variation in rates of primary cesarean and operative vaginal delivery in facilities of the Hospital Corporation of America during the year 2004.

Results: In 124 facilities representing almost 220,000 births during a 1-year period, the primary cesarean and operative vaginal delivery rates were 19% +/- 5% (range 9-37) and 7% +/- 4% (range 1-23). Within individual geographic regions, we consistently found variations of 200-300% in rates of primary cesarean delivery and variations approximating an order of magnitude for operative vaginal delivery.

Conclusion: Within broad upper and lower limits, rates of operative delivery in the United States are highly variable and suggest a pattern of almost random decision making. This reflects a lack of sufficient reliable, outcomes-based data to guide clinical decision making.

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