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(Reuters Health) – A French study suggests that pregnant women are less likely to have cesarean deliveries when they work in a hospital with more obstetricians and midwives among the staff.
In the 11 study hospitals, while the number of obstetricians per unit was increasing, the rate of caesarean section performed after the start of labor had decreased, said Saad Zbiri, director of the study at Versailles Saint Quentin University of Montigny-le. Saint-Bretonneux Hospital and Poissy Saint-Germain. And as the number of midwives per unit increased, fewer caesareans had been performed in advance.
Rates of caesareans have increased in developed countries in recent years, although the World Health Organization recommends this surgery for only about 10 to 15 percent of births when the health of the mother or baby is at risk.
Workforce reductions in maternity hospitals have contributed to this trend, Zbiri said by e-mail.
"We have shown that the woman's chances of having a caesarean section are affected by the number of women in the hospital where she gives birth," Zbiri added.
Zbiri and colleagues reviewed data on more than 102,000 deliveries between 2008 and 2014. Overall, about 24% of cesarean deliveries were performed.
On average, for every 200 deliveries each year, the study hospitals had about one obstetrician, three midwives and one anesthesiologist, the researchers said in PLoS ONE.
The study found that the number of anesthesiologists among the staff did not seem to influence the potential for cesarean delivery.
The researchers however calculated that a 10% increase in the number of full-time obstetricians was associated with a 2.5-point drop in the rate of caesarean section postpartum, 13.1 % to 10.6%.
And a 10% increase in the number of full-time midwives was associated with a 3.4 percentage point decrease in elective caesarean section, from 10.3% to 6.9%.
The study was not designed to demonstrate whether staffing levels could have a direct impact on caesarean section rates, or whether lower rates of caesarean sections could improve outcomes for maternal or maternal health. babies.
"One of the concerns when there is a shortage of providers is the ability to take care of everyone in an emergency," said Erin Wright, a researcher at the School of Nursing's 39 Johns Hopkins University in Baltimore who did not participate in the study.
"Although the article does not include this as a cause of causality, it is theoretically possible for providers to be able to more quickly decide on a caesarean delivery for a non-urgent patient if they have other patients to treat, "said Wright by email.
Although caesareans may be needed when the lives of mothers or babies are at risk, the surgery carries a risk of infection, excessive bleeding, damage to the reproductive organs and blood clots, said Saraswathi Vedam, researcher at the University of British Columbia. in Vancouver, Canada, who did not participate in the study.
Surgical deliveries can also lead to delays in breastfeeding and the establishment of links between the mother and the baby, as well as an increased risk of asthma and obesity in children. babies, "Vedam said by e-mail.
"Caesarean sections can only improve the overall health of the population if they are used to balance known or projected risks due to actual medical conditions such as maternal hypertension that could be cured by early delivery as opposed to (when they are used to react) staff constraints, "added Vedam.
SOURCE: https://bit.ly/2E2DS4n PLoS ONE, online November 28, 2018.
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