Caesarean Delivery Rate Review: An Evidence-Based Analysis.

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Services Research

Background:

• In 2007, caesarean deliveries accounted for 28% of all hospital births in Ontario, with rates increasing with maternal age and varying by region.
• The accepted caesarean delivery rate for low-risk maternal populations remains unclear, highlighting a need for further investigation.

Purpose of the Study:

• To systematically review literature to identify factors influencing caesarean delivery likelihood.
• To analyze Ontario's caesarean delivery rates and regional variations.

Main Methods:

• A mixed-methods approach combining a systematic literature review with an analysis of administrative and clinical data from Ontario hospital deliveries.
• Searched multiple databases including MEDLINE, Embase, CINAHL, and EBM Reviews for relevant publications.
• Utilized data from the Canadian Institute for Health Information and Better Outcomes and Registry Network.

Main Results:

• A systematic review identified 14 factors affecting caesarean delivery likelihood: 7 increased the likelihood, 2 decreased it, and 5 had no influence.
• Moderate-quality evidence suggests elective induction policies may decrease caesarean delivery rates in low-risk women compared to expectant management.
• The overall caesarean delivery rate in a very-low-risk Ontario population was 17%, with significant variation observed across different hospitals.

Conclusions:

• An induction policy is associated with a reduction in caesarean delivery rates for low-risk women.
• Significant variation in caesarean delivery rates exists among hospitals in Ontario.
• Limitations include a focus on systematic reviews from a 5-year period and potential inclusion of data from women with conditions warranting caesarean delivery in the 'low-risk' group.