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Variation in caesarean delivery rates

BMJ 2010; 341 doi: (Published 06 October 2010) Cite this as: BMJ 2010;341:c5255
  1. Marian Knight, senior clinical research fellow1,
  2. Elizabeth A Sullivan, associate professor2
  1. 1National Perinatal Epidemiology Unit, University of Oxford, Oxford OX3 7LF, UK
  2. 2Perinatal and Reproductive Epidemiology Unit, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
  1. marian.knight{at}

Specific risk groups should be monitored at a local level

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

BSIP, Boucharlat/Science Photo Library

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