The labor-adjusted cesarean section rate—A more informative method than the cesarean section “rate” for assessing a practitioner's labor and delivery skills

OBJECTIVE: Our purpose was to determine the benefits of an acuity-adjusted labor management tool. STUDY DESIGN: A retrospective review was performed of all deliveries at Good Samaritan Regional Medical Center in Phoenix, Arizona, for a 1-year period from Jan. 1 to Dec. 31, 1994. All physicians with ≥20 deliveries were included in the analysis. Patients with indications for which most practitioners would perform a cesarean delivery were removed from consideration. Physicians were then compared with respect to labor management in the remaining patients without relative contraindications to vaginal delivery. RESULTS: The total number of deliveries (n = 6062) was performed by 47 attending obstetricians, 9 perinatologists, an obstetrics-gynecology clinic, and a family practice clinic. The “raw” cesarean section rate was 20.1%. Those at high risk for cesarean delivery (n = 534) were excluded, leaving 684 cesarean sections performed in 5528 patients (12.4%) who were appropriate to labor. Differences were observed between the nulliparous cesarean section rate (16%) compared with that for parous patients (10.1%) (p < 0.0001 by Fisher's exact test (two-tailed) but not between attending obstetrician-gynecologists (12.4%) and perinatologists (13.8%) (not significant). CONCLUSION: A labor-adjusted cesarean section rate is more appropriate than just “raw” data. Medical, obstetric, and fetal factors affect a “raw” rate that is out of the control of the obstetrician. This method of assessing the labor and delivery skills of each practitioner and hospital would allow meaningful comparison with others. (Am J Obstet Gynecol 1997;177:139-43)