[Variability in the cesarean ratio and indications for the procedure among Spanish hospitals]

To describe variability in the cesarean ratio and indications for this procedure in women with and without a previous cesarean section.

We conducted a cross-sectional study of 111 hospitals (year 2010) categorized in six levels. Ten groups of indications for cesarean section were developed. Measures of central tendency and diversity were used to determine variability and the Kruskal-Wallis test was used for comparisons among hospital levels.

The percentage of cesarean sections was 25.4%. In women without a previous cesarean section, the percentage was higher in private and public hospitals with a lower technological level (34.7% and 30.4% in private and 22.4% in lower level public hospitals). Among public hospital levels, no differences in the percentage of cesarean sections indicated were observed.

Research on non-clinical factors could clarify the differences in the ratio of cesarean sections in private hospitals compared with public hospitals and among distinct levels of public hospitals.