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Monday
Mar012010

Quick Hit: Geographic Variation in the Appropriate Use of Cesarean Delivery

Geographic Variation in the Appropriate Use of Cesarean Delivery [pdf]

Variation in local medical opinion about the right cutoff for initiating a cesarean delivery, strengthened by available capacity and malpractice pressure, continues to be the best explanation for the facts in our analysis. In an era of soaring health care costs, where already strained public programs reimburse for cesarean delivery, it seems particularly important to consider the ramifications of intensive treatments whose medical benefits are uncertain when performed in less medically appropriate populations.

 

 

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Reader Comments (5)

So, not what's best for mom/baby, but "local practice," malpractice rates, and capacity. Economic considerations.

This confirms what I thought.

Jill, where does this come from/what is the source? It may be there, but I missed it :-)

March 2, 2010 | Unregistered CommenterAnne

Yep.

Try the link again. It's really slow to load but the whole paper is there.

March 2, 2010 | Registered CommenterJill

Read the whole thing and loved it. Birth factors only can be correlated in a maximum of 22% of cases? I was floored by that. When a patient has a c-section I'd expect birth factors to be correlated in 100% of cases. Why else would you do a cesarean? I know the authors include "mother's preference" as a possibility, but I just can't believe that in normal birth weight babies 40-82% of births could have "preference" if it could be counted. The fact that in normal weight babies, your geographic location matters more in assessing your risk of c-section than your actual physical health is astounding!

March 2, 2010 | Unregistered CommenterClarissa

Thanks. Added to the bibliography of my paper-to-be.

March 2, 2010 | Unregistered CommenterMomTFH

Great Paper. I knew this when I went to have my baby where I live, the NWT in Canada. Canada is a big country with a wide variation in c-section rates and practice; the fact that the c-section rate here is so low is very much determined by local economy and practice. Specifically, even here in the capital, there are few doctors, few resources and even less money. Therefore, if you get a c-section, chances are high that you actually needed it, since performing the surgery often required calling the on-call doctor in during the night (nurses run the floor here, no docs unless needed) and is actually more trouble for the hospital than if you delivered naturally. Consequently, they need to have a lot of faith in nature, and many procedures that are routine in other areas are out of the ordinary here. Certainly in times where morbidity or mortality is anticipated then they mobilize quickly, but I sometimes wonder if the fact that intervention is more of an inconvenience than a convenience for the establishment is what protects us from the same mass fate as some of our Southern sisters.

March 3, 2010 | Unregistered CommenterKristi
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