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Original ArticleOpen Access
Self-Evaluation of Obstetricians by Delivery Data to Reduce Cesarean Section Rate in Chai Nat Hospital
Kunthonkitidej K 
,
Ngemset O
,
Ngemset O KITTISAK KUNTHONKITIDEJ, M.D.*,
OPART NGERNSET, B.N., B.P.H.*
Introduction
: The cesarean section rate has continuously increased in recent years in
both public and private sector services. Various strategies have been proposed to reduce the cesa-
rean section rate, however, none of them has proven to be effective. Cesarean section rate at Chai
Nat Hospital climbed from 9.69 per cent in 1987 to 31.13 per cent in 1997. The authors have
attempted to reduce the unnecessary rate by creating a strategy of self-evaluation of obstetricians
by delivery data of each obstetrician. The objective of this study was to evaluate the effectiveness
of the strategy by comparing the cesarean section rate before and after using the strategy with the
assumption that the cesarean section rate would probably be decreased with the strategy.
Patients and Method
: The study was a clinical experimental research conducted from
January 1995 to December 1999, a sixty-month period. The target populations included obstetricians
and pregnant women delivering at Chai Nat Hospital. The cesarean section rate during the first
thirty months was compared with that of the latter thirty months, the period in which the strategy
was used. Furthermore, the cesarean section rate was also compared with that in Phra Phutthabat
Hospital.
Results
: The cesarean section rate in the first half of the study (30 months) at Chai Nat
Hospital, the period without the strategy, among 4,843 deliveries was 28.78 per cent compared
with 25.40 per cent among 5,044 cases in the second half of the study, the period using the stra-
tegy. The rate was significantly decreased (Z=3.79, P0.05). The comparison of cesarean
section rates during the first 30-months between Chai Nat and Phra Phutthabat Hospital during the
first half showed no significant difference (Z=0.66, P>0.05), whereas that during the second half
of the study between both hospitals was significantly different (Z=3.22, P
OPART NGERNSET, B.N., B.P.H.*
Introduction
: The cesarean section rate has continuously increased in recent years in
both public and private sector services. Various strategies have been proposed to reduce the cesa-
rean section rate, however, none of them has proven to be effective. Cesarean section rate at Chai
Nat Hospital climbed from 9.69 per cent in 1987 to 31.13 per cent in 1997. The authors have
attempted to reduce the unnecessary rate by creating a strategy of self-evaluation of obstetricians
by delivery data of each obstetrician. The objective of this study was to evaluate the effectiveness
of the strategy by comparing the cesarean section rate before and after using the strategy with the
assumption that the cesarean section rate would probably be decreased with the strategy.
Patients and Method
: The study was a clinical experimental research conducted from
January 1995 to December 1999, a sixty-month period. The target populations included obstetricians
and pregnant women delivering at Chai Nat Hospital. The cesarean section rate during the first
thirty months was compared with that of the latter thirty months, the period in which the strategy
was used. Furthermore, the cesarean section rate was also compared with that in Phra Phutthabat
Hospital.
Results
: The cesarean section rate in the first half of the study (30 months) at Chai Nat
Hospital, the period without the strategy, among 4,843 deliveries was 28.78 per cent compared
with 25.40 per cent among 5,044 cases in the second half of the study, the period using the stra-
tegy. The rate was significantly decreased (Z=3.79, P0.05). The comparison of cesarean
section rates during the first 30-months between Chai Nat and Phra Phutthabat Hospital during the
first half showed no significant difference (Z=0.66, P>0.05), whereas that during the second half
of the study between both hospitals was significantly different (Z=3.22, P
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