Zbiri et al. (PLoS One, 2018) assessed whether staffing levels of maternity units affect cesarean delivery rates
Population-based retrospective cohort study (2008-2014)
11 hospitals in a French perinatal network of differing sizes and organizations
The increase of cesarean delivery rates over recent decades might be attributable in part to changes in these levels, given that hospitals have gradually been induced to control their staff levels to reduce their costs
The study considered
Women’s demographic and medical characteristics
Type, organization, and staffing levels for
Obstetricians | Anesthesiologists | Midwives
Full-time equivalent (FTE) persons: Defined as 35 working hours per week per 100 deliveries
102,236 women with live deliveries | 24,470 cesarean deliveries
23.9% of the women had cesarean deliveries
2.4% urgent without labor
Urgent cesarean delivery prior to labor was not impacted by staffing levels (and made up a small percentage of cesarean deliveries overall)
The level of obstetricians (measured by the number of FTE persons) was inversely associated with intrapartum cesarean delivery
Adjusted odds ratio 0.55 (95% CI, 0.36–0.83; P-value = 0.005)
The level of midwives (measured by the number of FTE persons) was inversely associated with elective cesarean delivery
aOR 0.79 (95% CI 0.69–0.90; P-value < 0.001)
A 10% increase in obstetrician and midwife staff levels would have been associated with a decrease in the likelihood of
Intrapartum cesarean delivery by 2.5%
Elective cesarean delivery by 3.4%
These changes represent a decrease of
19% for intrapartum cesarean delivery rate
33% for elective cesarean delivery rate
Higher staffing levels of maternity units decreased rates of cesarean delivery
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