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In recent years a large number of medically unnecessary cesarean sections have being performed all over the country. At the Fundacion Clinica Valle del Lili, a private medical center in Cali, Colombia, a c-section rate of 66.2% was registered during the first 2 years of operation (1994-95), which increased to 67.8% in 1997-98. In 1998-99, attempts to lower these extremely high rates were addressed. Three strategies were implemented to achieve this goal: a) to allow patients from the national health system to get access to our service, b) to delegate the management of labor and delivery to female general practitioners, and c) to have a weekly group discussion of all c-sections performed by the staff. As a result, c-section rate decreased to 30.0% (27.1% for the patients coming from the national system and 57% for private patients) A significant reduction was observed in the 4 more frequent indications: previous c-section, dystocia, fetal distress and breech presentation. C-sections performed at patient's request showed a rate of 0.9%, all of them coming from the private patients. The importance of these findings is discussed.

Disminución de la tasa de operación cesárea en la Fundación Clínica Valle del Lili