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Clinical Trial
. 2018 Nov 28;13(11):e0207379.
doi: 10.1371/journal.pone.0207379. eCollection 2018.

Cesarean delivery rate and staffing levels of the maternity unit

Saad Zbiri  1 , Patrick Rozenberg  1   2 , François Goffinet  3   4 , Carine Milcent  5   6
Affiliations
Clinical Trial

Cesarean delivery rate and staffing levels of the maternity unit

Saad Zbiri et al. PLoS One. .

Abstract

Objective: To investigate whether staffing levels of maternity units affect prelabor urgent, elective, and intrapartum cesarean delivery rates.

Methods: This population-based retrospective cohort study covers the deliveries of the 11 hospitals of a French perinatal network in 2008-2014 (N = 102 236). The independent variables were women's demographic and medical characteristics as well as the type, organization, and staffing levels for obstetricians, anesthesiologists, and midwives of each maternity unit. Bivariate and multivariate analyses were conducted with multilevel logistic models.

Results: Overall, 23.9% of the women had cesarean deliveries (2.4% urgent before labor, 10% elective, and 11.5% intrapartum). Independently of individual- and hospital-level factors, the level of obstetricians, measured by the number of full-time equivalent persons (i.e., 35 working hours per week) per 100 deliveries, was negatively associated with intrapartum cesarean delivery (adjusted odds ratio, aOR 0.55, 95% confidence interval, CI 0.36-0.83, P-value = 0.005), and the level of midwives negatively associated with elective cesarean delivery (aOR 0.79, 95% CI 0.69-0.90, P-value < 0.001). Accordingly, a 10% increase in obstetrician and midwife staff levels, respectively, would have been associated with a decrease in the likelihood of intrapartum cesarean delivery by 2.5 percentage points and that of elective cesarean delivery by 3.4 percentage points. These changes represent decreases in intrapartum and elective cesarean delivery rates of 19% (from 13.1% to 10.6%) and 33% (from 10.3% to 6.9%), respectively.

Conclusion: Staffing levels of maternity units affect the use of cesarean deliveries. High staffing levels for obstetricians and midwives are associated with lower cesarean rates.

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Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Declercq E, Young R, Cabral H, Ecker J. Is a rising cesarean delivery rate inevitable? Trends in industrialized countries, 1987 to 2007. Birth 2011;38(2):99–104. 10.1111/j.1523-536X.2010.00459.x - DOI - PubMed
    1. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990–2014. PLoS One 2016;11(2):e0148343 10.1371/journal.pone.0148343 - DOI - PMC - PubMed
    1. Menacker F, Hamilton BE. Recent trends in cesarean delivery in the United States. NCHS Data Brief 2010;(35):1–8. - PubMed
    1. Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. Inequities in the use of cesarean section deliveries in the world. Am J Obstet Gynecol 2012;206(4):331.e1–19. - PubMed
    1. Betrán AP, Merialdi M, Lauer A, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007;21(2):98–113. 10.1111/j.1365-3016.2007.00786.x - DOI - PubMed