Identifying modifiable risk factors for a high caesarean section rate of primiparous women: a retrospective record review.

Abstract

Introduction: Primiparous women birthing at a level 5 regional hospital were identified to have a caesarean section in the upper quartile for Victorian Public Hospitals. We aimed to gain a detailed understanding of the characteristics, management and obstetric outcomes for primiparous women birthing at this centre in order to identify potentially modifiable factors the high caesarean section rate. Methods: Following ethics approval, a retrospective record review was undertaken of births between July 1 2014 and June 30 2015. Selection criteria were primiparity and gestation greater than 20 weeks. Records were identified via routinely collected data. Data was extracted manually and electronically. Analyses used descriptive and inferential statistics. Results: Records from 540 primipara were identified. Mean age was 26.8 years, mean BMI was 26.0. The mode of delivery was normal vaginal delivery in 44.1%; instrumental in 22.6%; caesarean section in 32.8%; and vaginal breech in 0.6%. Caesarean section rate was increased in women with epidural (41.%) increase of forceps and 30% of ventouse births.