EA 7285, Versailles Saint Quentin University, Montigny-le-Bretonneux, France.
Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France.
PLoS One. 2018 Nov 28;13(11):e0207379. doi: 10.1371/journal.pone.0207379. eCollection 2018.
To investigate whether staffing levels of maternity units affect prelabor urgent, elective, and intrapartum cesarean delivery rates.
This population-based retrospective cohort study covers the deliveries of the 11 hospitals of a French perinatal network in 2008-2014 (N = 102 236). The independent variables were women's demographic and medical characteristics as well as the type, organization, and staffing levels for obstetricians, anesthesiologists, and midwives of each maternity unit. Bivariate and multivariate analyses were conducted with multilevel logistic models.
Overall, 23.9% of the women had cesarean deliveries (2.4% urgent before labor, 10% elective, and 11.5% intrapartum). Independently of individual- and hospital-level factors, the level of obstetricians, measured by the number of full-time equivalent persons (i.e., 35 working hours per week) per 100 deliveries, was negatively associated with intrapartum cesarean delivery (adjusted odds ratio, aOR 0.55, 95% confidence interval, CI 0.36-0.83, P-value = 0.005), and the level of midwives negatively associated with elective cesarean delivery (aOR 0.79, 95% CI 0.69-0.90, P-value < 0.001). Accordingly, a 10% increase in obstetrician and midwife staff levels, respectively, would have been associated with a decrease in the likelihood of intrapartum cesarean delivery by 2.5 percentage points and that of elective cesarean delivery by 3.4 percentage points. These changes represent decreases in intrapartum and elective cesarean delivery rates of 19% (from 13.1% to 10.6%) and 33% (from 10.3% to 6.9%), respectively.
Staffing levels of maternity units affect the use of cesarean deliveries. High staffing levels for obstetricians and midwives are associated with lower cesarean rates.
研究妇产科单位人员配备水平是否会影响产前紧急、选择性和产时剖宫产率。
这是一项基于人群的回顾性队列研究，涵盖了法国围产期网络的 11 家医院在 2008 年至 2014 年期间的分娩情况（N=102236）。自变量是女性的人口统计学和医学特征以及每位妇产科单位的产科医生、麻醉师和助产士的类型、组织和人员配备水平。采用多水平逻辑模型进行了单变量和多变量分析。
总体而言，23.9%的女性行剖宫产术（2.4%产前紧急，10%选择性，11.5%产时）。在个体和医院水平因素之外，以每 100 例分娩中全职等效人数（即每周 35 小时工作时间）衡量的产科医生水平与产时剖宫产率呈负相关（调整后的优势比，aOR 0.55，95%置信区间，CI 0.36-0.83，P 值=0.005），助产士水平与选择性剖宫产率呈负相关（aOR 0.79，95%CI 0.69-0.90，P 值<0.001）。因此，产科医生和助产士人员配备水平分别提高 10%，则产时剖宫产率的可能性分别降低 2.5 个百分点和选择性剖宫产率降低 3.4 个百分点。这些变化分别代表产时和选择性剖宫产率降低 19%（从 13.1%降至 10.6%）和 33%（从 10.3%降至 6.9%）。
妇产科单位的人员配备水平会影响剖宫产的使用。产科医生和助产士的高人员配备水平与较低的剖宫产率相关。
