Variation in caesarean delivery rates

Rising rates of delivery by caesarean section are a cause of concern worldwide. Wide variation has been noted between countries—for example, caesarean delivery rates are 15% in the Netherlands but 38% in Italy.1 More than twofold differences in primary caesarean delivery rates have also been reported across regions in Canada,2 and between hospital delivery units in the United States and Australia.3 4 Although there is no consensus concerning the optimal caesarean delivery rate, it is clear that poor access to emergency obstetric care, and hence poor access to caesarean delivery, can harm both mother and infant.5 Conversely, high rates of operative delivery may result in poorer maternal and infant outcomes for the current or subsequent births.6 7 Variations in caesarean delivery rates have been attributed to differences in the characteristics of women giving birth. In the linked study (doi:10.1136/bmj.c5065), Bragg and colleagues assess whether the variation in unadjusted caesarean section rates between NHS trusts in England can be explained by maternal characteristics and clinical risk factors[f1].8

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