Improving Obstetric Practice Through Understanding Variation in Caesarean Section Rates in Irish Maternity Hospitals


Authors: Richard Layte , Aoife Brick

Research Areas: Health and Quality of Life

Abstract:
The ESRI in Collaboration with the Dept. of Obstetrics and Gynaecology, UCD has been awarded a three year Research Project Grant by the Health Research Board to study variation in caesarean section rates in Irish maternity hospitals and the factors contributing to the increasing trend in caesarean section in Ireland. Over the past 35 years there has been a sustained increase in the Caesarean section (CS) rate in developed countries including Ireland. In 1993, the Department of Health and Children in Ireland reported a CS rate of 13%. By 1999, the next year for which data are available, the rate was 20.4%, increasing to 26.9% by 2009. To date there has been little research on trends in CS in Ireland. In a recent publication the WHO (WHO et al 2009) have stated that there is no empirical evidence for an optimum percentage but questions remain as to why CS rates have been increasing over time. Significant variation in CS rates across hospitals in Ireland also raise concerns about the efficacy of the procedure in some instances. Rates of CS in Irish hospitals varied from 18.6% to 36.4% in 2009 and all but 3 of the 19 maternity units in the Irish hospital system experienced an increase in their CS rate over the period from 1999 to 2009. This project uses linked data from two national databases, the Hospital In-Patient Enquiry scheme (HIPE) and the National Perinatal Reporting System (NPRS) and an in depth prospective study from a large Dublin maternity hospital to investigate the factors that explain the increase in CS in Ireland and the pattern of variation across Irish hospitals. The project will investigate the role of changing maternal characteristics (e.g. increasing age, lower parity (previous births) and obesity), clinical risk factors for CS (e.g. malpresentation, pre-eclampsia, diabetes), changing clinical practices and organisational structures (e.g. private practice, staffing and policy). By understanding the processes associated with growing use of CS in Irish maternity hospitals the project will contribute to the development and improvement of policy and practice in maternity care.

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