Improving Obstetric Practice Through Understanding Variation in Caesarean Section Rates in Irish Maternity Hospitals

Lead Researcher:

Prof Richard Layte

Award Date:

1 January 2012

Host Institution:

Economic and Social Research Institute

Scheme:

Health Research Awards

Summary:

Over the past 35 years there has been a sustained increase in the caesarean section (CS) rate in developed countries including Ireland. In 1993, the Department of Health and Children in Ireland reported a CS rate of 13%. By 1999, the next year for which data were available, the rate was 20.4%, increasing to 26.9% by 2009. To date there has been little research on trends in CS in Ireland. In a recent publication the WHO (WHO et al 2009) have stated that there is no empirical evidence for an optimum percentage of births by CS but questions remain as to why CS rates have been increasing. Significant variation in CS rates across hospitals in Ireland also raises concerns about the efficacy of the procedure and the implications for health care costs. Rates of CS in Irish hospitals varied from 18.6% to 36.4% in 2009 and all but 3 of the 19 maternity units in the Irish hospital system experienced an increase in their CS rate over the period from 1999 to 2009.

This project uses linked data from two national databases, the Hospital In-Patient Enquiry scheme (HIPE) and the National Perinatal Reporting System (NPRS) and an in depth prospective study from a large Dublin maternity hospital to investigate the factors that explain the increase in CS in Ireland and the pattern of variation across Irish hospitals. The project will investigate the role of changing maternal characteristics (e.g. increasing age, lower parity (previous births) and obesity), clinical risk factors for CS (e.g. malpresentation, pre-eclampsia, diabetes), changing clinical practices and organisational structures (e.g. private practice, staffing and policy). By understanding the processes associated with growing use of CS in Irish maternity hospitals the project will contribute to the development and improvement of policy and practice in maternity care.