Is a twelve-percent cesarean section rate at a perinatal center safe?

OBJECTIVE

Our purpose was to examine the pregnancy and neonatal outcomes at a perinatal center with a consistent cesarean section rate approximately half the national average.

STUDY DESIGN

Ten years of vaginal delivery and cesarean section rates (1983 to 1992) and 5 years of mortality and morbidity outcomes (1988 to 1992) were compared with national health statistics and national health objectives.

RESULTS

The cesarean section rate during the 10-year period ranged from 10% to 15%, with an average of 12.5%. The cesarean section rate for the 5 years during which maternal and neonatal outcome data were obtained was 11.3%. The forceps and vacuum extraction rates during that time were consistently less than 5%. The nurse-midwifery service delivered approximately 36% of all babies during this period. In an examination of maternal mortality, we discovered only one death during the 5-year interval. The rate of maternal admission to the intensive care unit after delivery was 0.2%. The percent of women who received blood transfusions was 1%. The average length of stay for both vaginal and cesarean section deliveries declined steadily across the whole interval and was 2.5 days for a vaginal delivery and 5.5 days for a cesarean section. An examination of neonatal morbidity and mortality revealed an admission rate to the intensive care unit of less than 6%. The distribution of Apgar scores indicated less than 4% of neonates had scores < or = 3 at 1 minute; 0.5% had scores < or = 3 at 5 minutes. The neonatal death rate was 614 per 100,000 births, and fetal mortality was 729 per 100,000 births from 1988 to 1992.

CONCLUSIONS

The lowest safe cesarean section rate is not known; it will undoubtedly vary with location and patient mix. We believe that we have been able to establish a rate of cesarean section one half of the national average with good maternal and fetal outcomes. This has been accomplished through a vigorous prenatal care program, excellent perinatal and infertility services, a vigorous program of vaginal birth after cesarean section, and a competent nurse-midwifery service.