Reduction of the cesarean delivery rate in Ecuador
Sloan,Nancy L.; Pinto,E.; Calle,A.; Langer,Ana; Winikoff,Beverly; Fassihian,Goli
International Journal of Gynecology and Obstetrics 69(3): 229-236
Publication date: 2000
This quasi-experimental study tested a method to safely reduce the rate of cesarean delivery in Ecuador.
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).
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.
Case co-management, a simple, locally appropriate, and inexpensive intervention, safely reduced surgical delivery, hospital stay and cost of care.