Variation in cesarean section rates is not related to maternal and neonatal outcomes

Objective The aim of this study was to compare the rate of cesarean sections in 12 delivery units in Finland, and to assess possible associations between cesarean section rates and maternal and neonatal complications. Design Prospective multicenter cohort study. Setting The 12 largest delivery units in Finland. Population Total obstetric population between 1 January 2005 and 30 June 2005 (n = 19 764). Methods Prospectively collected data on 2496 cesarean sections and data derived from the Finnish Birth Register on all deliveries in these units were compared. Cesarean section rates and maternal complication rates were adjusted for known risk factors. Main outcome measures Cesarean section rate, maternal complications related to cesarean section, and neonatal asphyxia. Results The cesarean section rates varied significantly between the hospitals (12.9–25.1%, p < 0.0001), as did the maternal complication rates related to cesarean section (13.0–36.5%, p < 0.0001). There was no relation between maternal complications and the cesarean section rate. The differences remained after adjusting for risk factors. Neonatal asphyxia rates varied between 0.14 and 2.8% (p < 0.0001) and were not related to the cesarean section rates. Conclusions The rates of cesarean section, maternal complications and neonatal asphyxia vary markedly between different delivery units. Good maternal and neonatal outcomes can be achieved with cesarean section rates <15%.