Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study

Abstract

Objective: To use data from routine sources to compare rates of obstetric intervention in Europe both overall and for subgroups at higher risk of intervention.

Design: Retrospective analysis of aggregated routine data.

Setting: Thirty-one European countries or regions contributing data on mode of delivery to the Euro-Peristat project.

Population: Births in participating countries in 2010.

Methods: Countries provided aggregated data about overall rates of obstetric intervention and about caesarean section rates for specified subgroups.

Main outcome measures: Mode of delivery.

Results: Rates of caesarean section ranged from 14.8% to 52.2% of all births and rates of instrumental vaginal delivery ranged from 0.5% to 16.4%. Overall, there was no association between rates of instrumental vaginal delivery and rates of caesarean section, but similarities were observed between some countries that are geographically close and may share common traditions of practice. Associations were observed between caesarean section rates for women with breech and vertex births and with singleton and multiple births but patterns of association for women who had and had not had previous caesarean sections were more complex.

Conclusions: The persisting wide variations in caesarean section and instrumental vaginal delivery rates point to a lack of consensus about practice and raise questions for further investigation. Further research is needed to explore the impact of differences in clinical guidelines, healthcare systems and their financing and parents' and professionals' attitudes to care at delivery.

Keywords: Breech birth; Euro-Peristat; caesarean section; instrumental vaginal delivery; international comparisons; mode of delivery; parity; repeat caesarean section; twins.