The effect of restructuring of health care services on caesarean section rates

Objective. To review the anticipated changes in caesarean section (CS) rates following the restructuring of maternity health care services from regional to district level. Hypothesis. A change in provision of maternity services from regional to district level results in a decline in the CS rates. Method. A retrospective audit was undertaken of CS rates 3 months before and 3 months after the ‘down-scaling' of obstetric services from regional to district level at Addington Hospital, Durban. In addition the booking status of patients, indication for the CS, appropriateness of the CS decision and perinatal outcome were evaluated. Results. Despite a 32% reduction in the total number of deliveries, the CS rate was essentially unchanged following the restructuring of the obstetric service (24.6% and 22.9% for the two periods respectively). The proportion of CSs for complicated high-risk cases declined from 9.62% to 4%. The perinatal mortality rate decreased from 84.5/1 000 to 59.4/1 000 deliveries. An inappropriate decision for a CS was made in one-third of the cases. Conclusion. The restructuring of the health service and decline in the number of high-risk patients seen should have resulted in a decline in the CS rate. Lack of change in the latter may suggest possible influence of the skill of the health care providers. South African Journal of Obstetrics and Gynaecology Vol.11(2) 2005: 24-27