{
  "abstract": "Objectives Whangarei is a medium-sized public hospital in New Zealand, where maternity care is mainly provided by midwives and obstetric specialists, with little involvement in trainee doctors. In common with other services worldwide we have seen substantial increases in CS rates over recent years. The only area of practice likely to reduce overall CS is to avoid unnecessary CS in labour. We identified a 2.5-fold variation in labour CS rates between obstetricians in our hospital; individuals with high CS rates did not have better perinatal outcomes. The obstetric team expressed surprise at this variation and agreed it implied many CS were avoidable. We agreed to investigate whether annual feedback to obstetricians of individual CS rates against the overall hospital CS rate would encourage them to modify their practice.Method The birth records for the district were used to identify birth outcomes for the following: single pregnancy, cephalic presentation, spontaneous or induced labour at term (at least 37 weeks gestation) and no prior CS. These data were correlated with the obstetrician on duty each day to calculate labour CS rates for each obstetrician. Each year from 2022 to 2024, the obstetricians were presented with graphs, showing their annual rate over time against the overall department CS rate. The labour CS for obstetricians for 2021–22 (before feedback) was compared to 2023–23 (with feedback) to see if there were any identifiable changes in practice.Results From 2021 to 2024 the labour CS rate at Whangarei Hospital increased from 14.7% to 15.9%. Seven obstetricians who had worked in the unit across this time were included in the study. Feedback of individual CS data was not associated with any consistent change in CS over time. Three obstetricians had a small increase in CS, three a small decrease and one had no change. This study was challenging because of relatively small numbers leading to substantial year-by-year variation in individual CS rates, which is why multiple-year data were pooled.Conclusions Although the obstetricians were aware of how their practice compared with their peers, this did not appear to lead to changes in practice. This suggests that attitudes and beliefs about labour care may be largely fixed by the end of specialist training. Decisions for CS in labour are based on diagnosis of labour progress problems and suspected fetal compromise. Clearly there is a high degree of subjectivity in the way obstetricians practice. Any future attempts to change practice will need to be focussed on opinion leaders and future obstetricians in training.",
  "authors": [
    {
      "affiliations": [
        "Whangarei Hospital, Whangarei, New Zealand"
      ],
      "name": "David Bailey"
    }
  ],
  "title": "075 Variation in caesarean section (CS) rates in labour between obstetricians – can it be changed?",
  "uid": "0409838f-642c-51ea-a9cc-10a978ce257d"
}