Introducing caesarean section audit in a regional teaching hospital in The Netherlands

The increase in caesarean section rates is considered a reason for serious public health concern. With the objective to create awareness and initiate local discussion, obstetric audit was introduced in a regional teaching hospital in The Netherlands.

Caesarean section audit was introduced during the existing daily reports meetings from August 1, 2005 to June 1, 2006 in The Haga hospital, a large teaching hospital in The Hague, The Netherlands. All caesarean sections were discussed with regard to indication, classification and audited for 'lack of necessity'. For comparing intervention rates with the period prior to audit, Chi-square test with Yates correction for 2 x 2 tables was used.

Of 1221 deliveries, 228 were caesarean sections (18.7%) while prior to the audit period there were 1216 deliveries with 284 were caesarean sections (23.4%). The caesarean section rate is significantly lower during the audit period. Assisted vaginal deliveries, neonatal outcome, and induction of labor rates were comparable. Concerning the audit question 'could caesarean section have been prevented', there was discussion in 24.4% of cases. In 6.7% of caesarean sections, consensus about lack of necessity was achieved.

Introducing caesarean section audit during the existing structure of daily report meetings in a regional teaching hospital is both feasible and practical. It creates awareness and encourages discussion among staff members concerning indications for caesarean sections and lack of necessity. Furthermore, there was a significant decrease in caesarean section rate during the audit period.