title: Lack of local reflection of national changes in cesarean delivery rates: the Canadian experience.
abstract: OBJECTIVE
  The purpose of this study was to determine whether national changes in cesarean delivery rates were reflected in the rates of individual maternity units.
  
  
  METHODS
  Cesarean delivery rate changes among the 240 largest maternity units in Canada were compared with national cesarean delivery rate changes for the years 1983 through 1992. The periods of interest for cesarean delivery rate changes were 1983 through 1988 (a period of increasing national rates), 1988 through 1992 (a period of decreasing national rates), and 1983 through 1992 (a period with similar national rates at the end points).
  
  
  RESULTS
  For 1983-1988, 75% of the maternity units reflected changes that were not even in the same direction as those of the national mean changes. For the subperiods 1983-1992 and 1988-1992, these values were 48% and 53%, respectively.
  
  
  CONCLUSIONS
  National trends in cesarean delivery rates do not reflect a uniform shift among maternity units, demonstrating the limitations of national means as goals for local practice.
authors.affiliation: Graduate School of Business, Columbia University, New York, NY, USA.
authors.forename: V V
authors.initials: VV
authors.lastname: Richman
mesh_terms: D002170:Canada; D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D011247:Pregnancy