title: Reduction of the cesarean delivery rate in Ecuador.
abstract: OBJECTIVE
  This quasi-experimental study tested a method to safely reduce the rate of cesarean delivery in Ecuador.
  
  
  METHODS
  Hospital policy was modified to provide co-management for cesarean candidates at the major maternity hospital in Quito. Cesarean rates before (n=14743) and after (n=12351) the intervention were compared by chi-square and multiple logistic regression with other major maternity hospitals (before, n=12514; after, n=9590). Characteristics of cesarean candidates who had vaginal or cesarean deliveries in the intervention hospital were compared by chi-square (n=1584).
  
  
  RESULTS
  Cesarean rates declined by 4.5% (P<0.001) in the intervention hospital. A smaller (2.1%, P<0.01) reduction occurred in the other major public hospital in Quito where students of the co-principal investigator attempted to reduce cesarean delivery. Cesarean rates were unchanged in the public maternity hospitals of other major cities.
  
  
  CONCLUSIONS
  Case co-management, a simple, locally appropriate, and inexpensive intervention, safely reduced surgical delivery, hospital stay and cost of care.
authors.affiliation: Population Council, Dag Hammarskjold Plaza, New York, NY 10017, USA. nsloan@popcouncil.org
authors.forename: N L
authors.initials: NL
authors.lastname: Sloan
authors.forename: E
authors.initials: E
authors.lastname: Pinto
authors.forename: A
authors.initials: A
authors.lastname: Calle
authors.forename: A
authors.initials: A
authors.lastname: Langer
authors.forename: B
authors.initials: B
authors.lastname: Winikoff
authors.forename: G
authors.initials: G
authors.lastname: Fassihian
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D006771:Hospitals, Maternity; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D011050:Policy Making; D011247:Pregnancy; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*