[Increase of births by cesarean section in Campania in 2000]

Cesarean deliveries (CS) are increasing in Italy, especially in the Campania region, where they reached a peak incidence of 52% in the year 2000. This study analyses CS rate variability by hospital type, foetal risk factors (low birth-weight, prematurity, plurality, anomalous presentations), maternal characteristics (age and parity) and delivery time. Data are drawn from birth certificates of 31,182 babies, that is 64.2% of all delivered in 65 out of 98 Campania birth-places. 16,251 (52%) babies are born by CS; 559 (1.8%) by operative vaginal delivery. The Attributable Risk for foetal risk factors is 6.9%. In absence of these the CS rate would be 48.5% instead of 52%. CS rate of primigravid women was 53.2%. 63% of CS take place during morning hours and 93% on working days. CS rate is higher in private than in public hospitals (58 vs 46%), though foetal risk factors are lower. Rate of older women was higher in public hospitals, rate of primigravid women was higher in private ones. Campania data confirm the marginal role of foetal risk factors in the increase of CS rate. In order to reduce CS rates it seems reasonable to offer special support to primigravid low risk mothers and to provide behavioural obstetrical guidelines for the peculiar Italian reality.