Skip to main content

Advertisement

Log in

Analyzing the impact of private service on the cesarean section rate in public hospital Thailand

  • Materno-fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To assess the cesarean section rate and compare the risk profiles of cesarean delivery in nulliparous women between private and non-private service.

Materials and methods

The computerized delivery records, collected from June 2006 to May 2009 at Rajavithi Hospital were retrospectively reviewed. Of these, 11,049 term singleton nulliparous pregnant women without maternal chronic medical disease were divided into two groups; private and non-private group. Demographic data, cesarean section rate, indication for cesarean section, time of delivery, maternal and neonatal outcomes were assessed and analyzed.

Results

The cesarean section rate was markedly different between both groups. The cesarean rates of all pregnant women, women in private group and non-private group were 25.7% (2,841 out of 11,049), 67.3% (1,187 out of 1,765), and 17.8% (1,654 out of 9,284), respectively. The private group’s odds of having a cesarean delivery was 9.44 times [95% confidence interval (95% CI) 8.372–10.655] higher than the non-private group’s after adjusting for background differences (maternal age, race, gestational age and birth weight). The most common indications for cesarean delivery in private group were elderly gravida, unfavorable cervix and cephalopelvic disproportion. The private group had significantly higher operation rate in the office hours than that of non-private group (70.1 vs. 41.8%; p < 0.0001).

After adjusted for background differences, postpartum hemorrhage was significant higher in private group. Conversely, there was fewer admission to neonatal intensive care unit in private group. Low Apgar score at 5 min and perinatal death were not statistically significant in both groups. No cesarean hysterectomy and maternal death in both groups were noted.

Conclusions

Private patients had a significantly higher rate of cesarean section than non-private patients. NICU admission was significantly lower in the private group, but postpartum hemorrhage was significantly higher. There were no significant differences in maternal mortality, low Apgar score at 5 min, perinatal death in both group. This study suggests that a significant number of cesarean sections among private services may be unnecessary. To safely reduce a cesarean section rate, an appropriate policy and guideline for auditing cesarean section among private service should be developed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization (1985) Appropriate technology for birth. Lancet 2(8452):436–437

    Google Scholar 

  2. Usha Kiran TS, Jayawickrama NS (2002) Who is responsible for the rising caesarean section rate? J Obstet Gynaecol 22(4):363–365

    Article  PubMed  CAS  Google Scholar 

  3. Potter JE, Berquo E, Perpétuo IH, Leal OF, Hopkins K, Souza MR, Formiga MC (2001) Unwanted caesarean sections among public and private patients in Brazil: prospective study. BMJ 323:1155–1158

    Article  PubMed  CAS  Google Scholar 

  4. Murray SF (2000) Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study. Br Med J 321(7275):1501–1505

    Article  CAS  Google Scholar 

  5. Lee SI, Khang YH, Lee MS (2004) Women’s attitudes toward mode of delivery in South Korea—a society with high cesarean section rates. Birth 31(2):108–116

    Article  PubMed  Google Scholar 

  6. Tampakoudis P, Assimakopoulos E, Grimbizis G, Zafrakas M, Tampakoudis G, Mantalenakis S, Bontis J (2004) Cesarean section rates and indications in Greece: data from a 24-year period in a teaching hospital. Clin Exp Obstet Gynecol 31(4):289–292

    PubMed  CAS  Google Scholar 

  7. Florica M, Stephansson O, Nordstrom L (2006) Indications associated with increased cesarean section rates in a Swedish hospital. Int J Gynaecol Obstet 92(2):181–185

    Article  PubMed  CAS  Google Scholar 

  8. Penn Z, Ghaem-Maghami S (2001) Indications for caesarean section. Best Pract Res Clin Obstet Gynaecol 15(1):1–15

    Article  PubMed  CAS  Google Scholar 

  9. Tangcharoensathien V (1997) Pattern of hospital delivery in Thailand during 1990–1996, health system research institute, Bangkok

  10. Lumbiganon P, Laopaiboon M, Gulmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, Attygalle DE, Shrestha N, Mori R, Nguyen DH, Hoang TB, Rathavy T, Chuyun K, Cheang K, Festin M, Udomprasertgul V, Germar MJ, Yanqiu G, Roy M, Carroli G, Ba-Thike K, Filatova E, Villar J (2010) Method of delivery and pregnancy outcomes in Asia: the who global survey on maternal and perinatal health 2007–2008. Lancet 375(9713):490–499. doi:10.1016/S0140-6736(09)61870-5

    Article  PubMed  Google Scholar 

  11. Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, Velazco A, Bataglia V, Langer A, Narvaez A, Valladares E, Shah A, Campodonico L, Romero M, Reynoso S, de Padua KS, Giordano D, Kublickas M, Acosta A (2007) Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 335(7628):1025

    Article  PubMed  Google Scholar 

  12. Burrows LJ, Meyn LA, Weber AM (2004) Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol 103(5(Pt 1)):907–912. doi:10.1097/01.AOG.0000124568.71597.ce

    Article  PubMed  Google Scholar 

  13. ACOG (2007) ACOG Committee Opinion No. 394, December. Cesarean delivery on maternal request. Obstet Gynecol 110(6):1501

    Google Scholar 

  14. Lagrew DC Jr, Adashek JA (1998) Lowering the cesarean section rate in a private hospital: comparison of individual physicians’ rates, risk factors, and outcomes. Am J Obstet Gynecol 178(6):1207–1214

    Article  PubMed  Google Scholar 

  15. ACOG (2006) ACOG Practice Bulletin: clinical management guidelines for obstetrician–gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 108(4):1039–1047

    Google Scholar 

  16. ACOG (2002) ACOG Practice Bulletin. Diagnosis and management of preeclampsia and eclampsia. Obstet Gynecol 99(1):159–167

    Google Scholar 

  17. ACOG (2009) ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 114 (1):192–202. doi:10.1097/AOG.0b013e3181aef106

  18. Almeida S, Bettiol H, Barbieri MA, Silva AA, Ribeiro VS (2008) Significant differences in cesarean section rates between a private and a public hospital in brazil. Cad Saude Publ 24(12):2909–2918

    Article  Google Scholar 

  19. Angeja AC, Washington AE, Vargas JE, Gomez R, Rojas I, Caughey AB (2006) Chilean women’s preferences regarding mode of delivery: which do they prefer and why? BJOG 113(11):1253–1258

    Article  PubMed  CAS  Google Scholar 

  20. Braveman P, Marchi K, Egerter S, Kim S, Metzler M, Stancil T, Libet M (2010) Poverty, near-poverty, and hardship around the time of pregnancy. Matern Child Health J 14(1):20–35. doi:10.1007/s10995-008-0427-0

    Article  PubMed  Google Scholar 

  21. Habiba M, Kaminski M, Da Fre M, Marsal K, Bleker O, Librero J, Grandjean H, Gratia P, Guaschino S, Heyl W, Taylor D, Cuttini M (2006) Caesarean section on request: a comparison of obstetricians’ attitudes in eight European countries. BJOG 113(6):647–656

    Article  PubMed  CAS  Google Scholar 

  22. Bettes BA, Coleman VH, Zinberg S, Spong CY, Portnoy B, DeVoto E, Schulkin J (2007) Cesarean delivery on maternal request: obstetrician–gynecologists’ knowledge, perception, and practice patterns. Obstet Gynecol 109(1):57–66

    Article  PubMed  Google Scholar 

  23. Lin HC, Xirasagar S (2004) Institutional factors in cesarean delivery rates: policy and research implications. Obstet Gynecol 103(1):128–136

    Article  PubMed  Google Scholar 

  24. Paranjothy S, Frost C, Thomas J (2005) How much variation in cs rates can be explained by case mix differences? BJOG 112(5):658–666

    Article  PubMed  CAS  Google Scholar 

  25. Poma PA (1999) Effects of obstetrician characteristics on cesarean delivery rates. A community hospital experience. Am J Obstet Gynecol 180(6(Pt 1)):1364–1372

    Article  PubMed  CAS  Google Scholar 

  26. Mawson AR (2002) Reducing cesarean delivery rates in managed care organizations. Am J Manage Care 8(8):730–740

    Google Scholar 

  27. Peipert JF, Hogan JW, Gifford D, Chase E, Randall R (1999) Strength of indication for cesarean delivery: comparison of private physician versus resident service labor management. Am J Obstet Gynecol 181(2):435–439

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Podjanee Phadungkiatwattana.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Phadungkiatwattana, P., Tongsakul, N. Analyzing the impact of private service on the cesarean section rate in public hospital Thailand. Arch Gynecol Obstet 284, 1375–1379 (2011). https://doi.org/10.1007/s00404-011-1867-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-011-1867-0

Keywords

Navigation