The influence of patient preferences and physician practices on cesarean delivery

PURPOSE OF INVESTIGATIONS: A wide range of variation exists between the cesarean delivery rates of individual obstetricians in our health district, despite an overall cesarean delivery rate below the national average. This study tested the hypothesis that physician and patient determinants influenced the decision to perform a cesarean delivery by investigating its preventability at a tertiary care medical center.

A retrospective analysis of the medical records of 290 unselected patients who had a term primary cesarean delivery during a twelve-month period was conducted. Patient characteristics, indications for, and preventability of cesarean delivery were determined for each patient.

Overall, 66 (23%) of the 290 term cesarean deliveries were deemed preventable: 41 (62%) of the 66 cases were deemed preventable by patients and the other 25 (38%) by obstetricians. The preventable cesarean section rate was significantly higher for local residents as compared to referrals (27% vs. 15%; p = 0.001), the two main indications accounting for preventability being dystocia (53%) and breech presentation (23%).

The preferences of patients and practices of obstetricians influence recourse to cesarean delivery. Addressing the practices for the clinical management of breech and dystocia by obstetricians and the preferences of patients for their choice of mode of delivery will facilitate the appropriate utilization of cesarean delivery.