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Cesarean delivery rate and staffing levels of the maternity unit

Author

Listed:
  • Saad Zbiri

    (RISCQ - Risques cliniques et sécurité en santé des femmes et en santé périnatale - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines)

  • Patrick Rozenberg

    (Service de gynécologie et obstétrique [CHI Poissy-Saint Germain] - CHI Poissy-Saint-Germain, RISCQ - Risques cliniques et sécurité en santé des femmes et en santé périnatale - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines)

  • François Goffinet

    (Service de Gynécologie et Obstétrique [Cochin] - Hôpital Cochin [AP-HP] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP), CRESS - U1153 - Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique - UPD5 - Université Paris Descartes - Paris 5 - CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité - INRA - Institut National de la Recherche Agronomique - UPD7 - Université Paris Diderot - Paris 7 - UPD5 - Université Paris Descartes - Paris 5 - USPC - Université Sorbonne Paris Cité - INSERM - Institut National de la Santé et de la Recherche Médicale, Hôpital Cochin [AP-HP] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP), UPD5 - Université Paris Descartes - Paris 5)

  • Carine Milcent

    (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique, PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)

Abstract

Objective To investigate whether staffing levels of maternity units affect prelabor urgent, elective, and intrapartum cesarean delivery rates. Methods This population-based retrospective cohort study covers the deliveries of the 11 hospitals of a French perinatal network in 2008–2014 (N = 102 236). The independent variables were women's demographic and medical characteristics as well as the type, organization, and staffing levels for obstetricians, anesthesiologists, and midwives of each maternity unit. Bivariate and multivariate analyses were conducted with multilevel logistic models. Results Overall, 23.9% of the women had cesarean deliveries (2.4% urgent before labor, 10% elective, and 11.5% intrapartum). Independently of individual- and hospital-level factors, the level of obstetricians, measured by the number of full-time equivalent persons (i.e., 35 working hours per week) per 100 deliveries, was negatively associated with intrapartum cesarean delivery (adjusted odds ratio, aOR 0.55, 95% confidence interval, CI 0.36–0.83, P-value = 0.005), and the level of midwives negatively associated with elective cesarean delivery (aOR 0.79, 95% CI 0.69–0.90, P-value

Suggested Citation

  • Saad Zbiri & Patrick Rozenberg & François Goffinet & Carine Milcent, 2018. "Cesarean delivery rate and staffing levels of the maternity unit," PSE-Ecole d'économie de Paris (Postprint) halshs-01960301, HAL.
    • Handle: RePEc:hal:pseptp:halshs-01960301
    DOI: 10.1371/journal.pone.0207379
    Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-01960301v1
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    References listed on IDEAS

    as
    1. Clark, Andrew E. & Milcent, Carine, 2011. "Public employment and political pressure: The case of French hospitals," Journal of Health Economics, Elsevier, vol. 30(5), pages 1103-1112.
    2. repec:hal:psewpa:halshs-01724086 is not listed on IDEAS
    3. Carine Milcent & Saad Zbiri, 2018. "Prenatal care and socioeconomic status: effect on cesarean delivery," Health Economics Review, Springer, vol. 8(1), pages 1-21, December.
    4. Grant, Darren, 2009. "Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project," Journal of Health Economics, Elsevier, vol. 28(1), pages 244-250, January.
    5. repec:hal:wpaper:halshs-01724086 is not listed on IDEAS
    6. repec:hal:pseptp:halshs-01785750 is not listed on IDEAS
    7. repec:hal:journl:halshs-01785750 is not listed on IDEAS
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    Cited by:

    1. Carine Milcent & Saad Zbiri, 2022. "Supplementary private health insurance: The impact of physician financial incentives on medical practice," Health Economics, John Wiley & Sons, Ltd., vol. 31(1), pages 57-72, January.
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    3. Arno Stöcker & Holger Pfaff & Nadine Scholten & Ludwig Kuntz, 2025. "Exploring the influence of medical staffing and birth volume on observed-to-expected cesarean deliveries: a panel data analysis of integrated obstetric and gynecological departments in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(6), pages 987-1022, August.
    4. Saad Zbiri & Patrick Rozenberg & Carine Milcent, 2024. "Staff Resources in Public and Private Hospitals and Their Implication for Medical Practice: A French Study of Caesareans," Post-Print hal-04626835, HAL.

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