What is the optimal caesarean section rate?
STUDY OBJECTIVE–To investigate the consequences of different levels of caesarean section (CS) rate in terms of fetal and maternal outcomes. DESIGN–Comparison of outcome variables between four categories of maternity units stratified according to CS rates. Data were collected concurrently. SETTINGS–All 17 maternity units in one health region. SUBJECTS–Data for the perinatal mortality analysis: all 221,867 deliveries in 1983-87 (excluding severe malformations) (1462 deaths); maternity information analysis system: all 36,727 women with singleton pregnancies who delivered in 1988. OUTCOME MEASURES–Perinatal mortality, Apgar scores at one and five minutes, onset of respiration after one minute, postnatal transfusion, postnatal infection, thromboembolism, low haemoglobin concentration at discharge, and puerperal psychosis were determined. RESULTS–Teaching hospitals with an increased proportion of high risk cases had the highest CS rate, but the other three categories were found to serv
