Self-evaluation of obstetricians by delivery data to reduce cesarean section rate in Chai Nat Hospital

The cesarean section rate has continuously increased in recent years in both public and private sector services. Various strategies have been proposed to reduce the cesarean section rate, however, none of them has proven to be effective. Cesarean section rate at Chai Nat Hospital climbed from 9.69 per cent in 1987 to 31.13 per cent in 1997. The authors have attempted to reduce the unnecessary rate by creating a strategy of self-evaluation of obstetricians by delivery data of each obstetrician. The objective of this study was to evaluate the effectiveness of the strategy by comparing the cesarean section rate before and after using the strategy with the assumption that the cesarean section rate would probably be decreased with the strategy.

The study was a clinical experimental research conducted from January 1995 to December 1999, a sixty-month period. The target populations included obstetricians and pregnant women delivering at Chai Nat Hospital. The cesarean section rate during the first thirty months was compared with that of the latter thirty months, the period in which the strategy was used. Furthermore, the cesarean section rate was also compared with that in Phra Phutthabat Hospital.

The cesarean section rate in the first half of the study (30 months) at Chai Nat Hospital, the period without the strategy, among 4,843 deliveries was 28.78 per cent compared with 25.40 per cent among 5,044 cases in the second half of the study, the period using the strategy. The rate was significantly decreased (Z=3.79, P<0.001). At Phra Phutthabat Hospital where the strategy was not used, the cesarean section rate during the first 30-month period was 29.36 per cent among 5,868 deliveries and 28.12 per cent among 6,020 deliveries during the second half of the study. The rates were not significantly different (Z=1.49, P>0.05). The comparison of cesarean section rates during the first 30-months between Chai Nat and Phra Phutthabat Hospital during the first half showed no significant difference (Z=0.66, P>0.05), whereas that during the second half of the study between both hospitals was significantly different (Z=3.22, P<0.01).

The strategy of self-evaluation of obstetricians by delivery data of each obstetrician could significantly reduce the cesarean section rate (P<0.001). If the strategy is implemented in larger areas of Thailand, a large number of unnecessary cesarean sections as well as maternal morbidity could be avoided, resulting in saving a lot of national expense and also improving the standard of care in obstetrics.