The Impact of the Health Care Reform Plan on the Rate of Caesarean Section in the Educational Hospital: A Case Study

Background: In recent years, the tendency of women to have C-section hasincreased, without enough knowledge about it and its side-effects. Vaginal birthpromotion program is one of programs included in the health care reform planwhich is an important step in promoting the awareness of vaginal birth. The aim ofthis study is to investigate the impact of the health care reform plan on C-sectionrates in one of educational hospitals in Tehran University of Medical Science.Methods: The present study was descriptive-analytic which was conducted inlongitudinal and retrospective manner. Data were collected from 8510 deliveriesthrough the patients medical records in the span of three consecutive years, oneyear before implementing the health care reform plan and two years after itsimplementation. Calculations were done via Excel and SPSS 20 soft wares.Results: From the total of 2309 deliveries in 2013, (before implementing the plan), 69percent of them had C-section and 31 percent had vaginal delivery. In the first year ofthe plan, from a total of 2989 deliveries, 70.8 percent had C-section and 29.2 percenthad vaginal delivery and in the second year, from a total of 3212 deliveries, 71.3percent had C-section and 28.6percent had vaginal delivery. The rate of avoidable Csectionsin 2013, was 21.6 %, in 2014, 14.8 % and in 2014, 15 % .The execution ofhealth care reform plan led to a 6.7 % decline rate in avoidable C-sections such aselective caesarians.(p = 0.001). Among the reasons for non-avoidable caesarians are,repeated caesarian, failure in delivery, and preeclampsia, respectively.Conclusion: Although this hospital did not succeed in reducing the rate of C-section,considering the causes for C-section, it could reduce avoidable caesarians like electivedeliveries. Given that this hospital has a large number of critically ill patientsreferred from other centers for C-section, it has a high rate of C-section. Twoimportant factors contributing to the execution of this program are, making thedelivery room s space pleasant according to the birth center standards, andincreasing human resources and professional and friendly obstetricians. Therefore,in order to promote vaginal birth a comprehensive planning is needed.

Keywords:

Vaginal Birth Promotion Program , Health Care Reform Plan , Investigation