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Reduction of the cesarean delivery rate in Ecuador
Author(s) -
Sloan N.L.,
Pinto E.,
Calle A.,
Langer A.,
Winikoff B.,
Fassihian G.
Publication year - 2000
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/s0020-7292(00)00192-2
Subject(s) - medicine , cesarean delivery , logistic regression , obstetrics , intervention (counseling) , vaginal delivery , chi square test , public hospital , pregnancy , emergency medicine , nursing , statistics , genetics , mathematics , biology
Abstract Objective: This quasi‐experimental study tested a method to safely reduce the rate of cesarean delivery in Ecuador. Method: Hospital policy was modified to provide co‐management for cesarean candidates at the major maternity hospital in Quito. Cesarean rates before ( n =14 743) and after ( n =12 351) the intervention were compared by chi‐square and multiple logistic regression with other major maternity hospitals (before, n =12 514; after, n =9590). Characteristics of cesarean candidates who had vaginal or cesarean deliveries in the intervention hospital were compared by chi‐square ( n =1584). Result: Cesarean rates declined by 4.5% ( P <0.001) in the intervention hospital. A smaller (2.1%, P <0.01) reduction occurred in the other major public hospital in Quito where students of the co‐principal investigator attempted to reduce cesarean delivery. Cesarean rates were unchanged in the public maternity hospitals of other major cities. Conclusion: Case co‐management, a simple, locally appropriate, and inexpensive intervention, safely reduced surgical delivery, hospital stay and cost of care.