Geospatial variation in caesarean delivery.
Jennifer Vanderlaan, Johnathan A Edwards, Anne Dunlop
PMID 32089861WHAT IT FOUND
Primary and repeat caesarean rates varied widely across Georgia counties.
High primary caesarean clusters had fewer providers, less midwife availability, rural residence, more Medicaid births and more births to minority women. This is county-level variation, not proof of unnecessary surgery.
Key findings
01Primary caesarean delivery rates varied from 120 to 317 per 1,000 live births across Georgia counties, and first and fourth quartile counties differed significantly.
02Repeat caesarean delivery rates varied from 778 to 1,000 per 1,000 births, with a significant difference between first and fourth quartile counties.
03Counties in high primary caesarean clusters had fewer providers, more Medicaid-paid births, more births to minority women, less midwife and hospital availability, and were more rural.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis was by maternal county of residence, not by individual woman, so it cannot show why any woman had a caesarean or whether it was clinically necessary. County-level aggregation may hide clusters within large urban counties. Access was measured as presence of any maternity hospital or midwife in a service area, not distance, hospital level, bed size or teaching status. Family physicians were not included because data were not available. Linkage was successful for over 86% of live births, so some deliveries may not be represented. The study is observational, so associations with providers, Medicaid, minority status and rural residence do not prove cause. The authors note that some non-significant findings, such as minority status and repeat caesarean, may be due to limited power.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that a caesarean delivery was unnecessary or that adding midwives would lower rates. The study analysed county-level records, not individual clinical decisions, and cannot determine why women had caesarean or whether transfer options were available.