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Updated: Aug 11, 2026
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
Quality of obstetric care and risk-adjusted primary cesarean delivery rates
Jennifer L Bailit1, Thomas E Love, Neal V Dawson
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA.
Objective:
The purpose of this study was to examine the association between risk-adjusted primary cesarean delivery rates and maternal and neonatal outcomes.
Study Design:
California birth certificate data that were linked to hospital discharge data for 2001 were used to create a primary cesarean delivery rate risk-adjustment model. Two hundred eighty-five hospitals were divided into 3 groups that were above, below, or within expected rate confidence intervals. Maternal and neonatal outcomes were compared within each of the 3 hospital groupings.
Results:
Of the 285 hospitals, 27% had primary cesarean delivery rates that were above expected confidence intervals; 34% had primary cesarean delivery rates that were below expected confidence intervals, and 39% had primary cesarean delivery rates that were within expected confidence intervals. Neonatal asphyxia rates were higher in hospitals that had lower than expected rates of cesarean deliveries (0.05%, 0.1%, 0.07% for above, below, and within the confidence intervals, respectively; P < .0001). Maternal infection rates (2.1%, 2.3%, 1.8%, respectively; P < .0001) and third-degree tears (2.3%, 3.0%, 2.6%, respectively; P < .0001) were also higher in hospitals for which the cesarean delivery rates were above or below the expected rates.
Conclusion:
Risk-adjusted primary cesarean delivery rates are a good marker for maternal and neonatal outcomes.
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