BACKGROUND AND PURPOSE: 

• Zbiri et al. (PLoS One, 2018) assessed whether staffing levels of maternity units affect cesarean delivery rates

METHODS: 

• Population-based retrospective cohort study (2008-2014) 
  • 11 hospitals in a French perinatal network of differing sizes and organizations  
• Hypothesis 

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

RESULTS: 

• 102,236 women with live deliveries | 24,470 cesarean deliveries  
• 23.9% of the women had cesarean deliveries 
  • 2.4% urgent without labor 
  • 10% elective 
  • 11.5% intrapartum  
• 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

CONCLUSION: 

• Higher staffing levels of maternity units decreased rates of cesarean delivery

Learn More – Primary Sources: 

Cesarean delivery rate and staffing levels of the maternity unit

Related ObG Topics:

Cesarean Delivery Best Practices & Guidelines – The ERAS Committee Recommendations

Can Evidence-Based Interventions Reduce C-section Complications?