Format

Send to

Choose Destination
Health Policy. 2018 Apr;122(4):367-372. doi: 10.1016/j.healthpol.2018.01.016. Epub 2018 Feb 10.

Health policies for the reduction of obstetric interventions in singleton full-term births in Catalonia.

Author information

1
Ministry of Health, Generalitat de Catalunya, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain. Electronic address: mjpueyo@gencat.cat.
2
Mar University School of Nursing, Pompeu Fabra University, Barcelona, Spain.
3
School of Community Health and Midwifery, University of Central Lancashire, Preston, UK.
4
School of Nursing, Rovira i Virgili University, Tarragona, Spain.
5
Faculty of Medicine, Alcalá University, Madrid, Spain.
6
Hospital Sant Joan de Reus, Tarragona, Spain.
7
Hospital Comarcal d'Amposta, Tarragona, Spain.
8
PhD Programme in Paediatrics, Obstetrics and Gynaecology, Autonomous University of Barcelona, Barcelona, Spain.
9
Faculty of Economic and Business Sciences, Pompeu Fabra University, Barcelona, Spain.

Abstract

AIM:

To explore the effect of hospital's characteristics in the proportion of obstetric interventions (OI) performed in singleton fullterm births (SFTB) in Catalonia (2010-2014), while incentives were employed to reduce C-sections.

METHODS:

Data about SFTB assisted at 42 public hospitals were extracted from the dataset of hospital discharges. Hospitals were classified according to the level of complexity, the volume of births attended, and the adoption of a non-medicalized delivery (NMD) strategy. The annual average change in the percentage for OI was calculated based on Poisson regression models.

RESULTS:

The rate of OI (35% of all SFTB) including C-sections (20.6%) remained stable through the period. Hospitals attending less complex cases had a lower average of OI, while hospitals attending lower volumes had the highest average. Higher levels of complexity increased the use of C-sections (+4% yearly) and forceps (+16%). The adoption of the NMD strategy decreased the rate of C-sections.

CONCLUSIONS:

The proportion of OI, including C-sections, remained stable in spite of public incentives to reduce them. The adoption of the NMD strategy could help in decreasing the rate of OI. To reduce the OI rate, new strategies should be launched as the development of low-risk pregnancies units, alignment of incentives and hospital payment, increased value of incentives and encouragement of a cultural shift towards non-medicalized births.

KEYWORDS:

Cesarea; Health policies; Level of complexity; Non-medicalized delivery; Obstetric interventions; Volume of births

PMID:
29452718
DOI:
10.1016/j.healthpol.2018.01.016
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center