Controlling the rise in cesarean section rates by the dissemination of information from vital records.

The recent rapid increase in cesarean childbirth is a source of growing public health concern. We suggest that one method of ameliorating the rise would be to disseminate hospital-specific cesarean section rates. To make such rates comparable between hospitals, it is necessary to adjust for variations in maternal and newborn factors associated with cesarean section. We therefore applied an indirect standardization technique to three years of California vital records data. The results show sizable variations in cesarean section rates among individual hospitals and by hospital type, both before and after standardization. For such a method to be effective, complete and accurate information from birth certificates is an obvious prerequisite.