Influence of audit and feedback on use of caesarean section in a geographically-defined population

The influence of audit and feedback on use of caesarean section was investigated in a geographically defined population. At the beginning of 1986 and throughout that year the three principal reasons for the increased use of caesarean section were drawn to the attention of the resident obstetricians in the hospital where 85% of the women resident in the health district gave birth. A repeat survey of the indications for caesarean section was conducted for 1986 births. Despite an increase in the number of women delivered in 1986 who had previously had two or more sections, the caesarean section rate fell from 15.9% in 1982 to 12.7% in 1986 (P < 0.005). Most of this decrease was due to a reduction in caesarean section for the three indications that were the main contributors to the increased rate between 1974 and 1982. The rate for the women who gave birth in the hospital whose resident obstetricians had been informed about the preceding audit was 12.2%, compared with 15.6%, for the women who gave birth in other hospitals. Audit and feedback of specific information, imparted in a non-directive way to resident obstetricians responsible for performing caesarean section, probably accounted for a more rational use of caesarean section.