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

ABSTRACT

Objective: To examine 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 decrease in CS rates. Method: A retrospective audit was undertaken of CS rates 3 months before (1 April-30 June 2001) and 3 months after (1 August-31 October 2001) the 'down-scaling' of obstetric services from regional to district level at Addington Hospital; Durban; South Africa. In addition; the booking status of patients; indication for CS; appropriateness of CS decision; and perinatal outcome were evaluated. Results: The total number of deliveries before and after the restructuring of health care services decreased 2070 to 1409. Despite this 32 reduction in the total number of deliveries; the CS rate was essentially unchanged following the restructuring of the obstetric service (24.6 vs. 22.9). The proportion of CS for complicated high-risk cases decreased from 9.62 to 4. The perinatal mortality rate decreased from 84.5/1000 to 59.4/1000 deliveries. An inappropriate decision for CS was made in one-third of the cases. Conclusion: The restructuring of the health service and decrease in the number of high-risk patients seen should have resulted in a decrease in CS rate. Lack of change in the latter may suggest possible influence of the skill of health care providers