title: Cesarean births in Taiwan.
abstract: OBJECTIVE
  To evaluate the use of cesarean delivery in Taiwan by comparing local clinical indications with those in international cohorts.
  
  
  METHODS
  In-patient claims from the National Health Insurance (NHI) in Taiwan were analyzed. Indications for cesarean delivery were evaluated with primary diagnosis codes and procedure codes from the NHI dataset. To produce a stable numerator for cesarean section, 3 years (1998-2000) of claims for cesarean delivery were abstracted and annualized.
  
  
  RESULTS
  Rates ranged between 27.3% and 28.7% for primary cesarean delivery and were below 5% for vaginal birth after a cesarean section (VBAC). Compared with rates in other countries, rates for overall and primary cesarean section as well as for VBAC were significantly higher in medical centers in Taiwan (P<0.001). However, the clinics contributed the most to the difference in both overall and primary cesarean rates. The most common indication for cesarean section was prior cesarean section (43.3%-45.5%), followed by malpresentation (19.6%-23.4%). The proportion of fetuses with malpresentation delivered by cesarean section in Taiwan was 7.9%, almost twice the upper limit expected for all pregnancies as indicated in international studies.
  
  
  CONCLUSIONS
  It is important to use appropriately documented data and to compare them with international data when monitoring local obstetric practices. The disproportionately high cesarean delivery rates in Taiwan may hold major lessons for the many countries contemplating or having universal health insurance coverage with a similar mix of providers.
authors.affiliation: Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan. hsu4426@ms4.hinet.net
authors.forename: Chin-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: J C
authors.initials: JC
authors.lastname: Lo
authors.forename: Jui-Hsing
authors.initials: JH
authors.lastname: Chang
authors.forename: Chie-Pein
authors.initials: CP
authors.lastname: Chen
authors.forename: Suchuan
authors.initials: S
authors.lastname: Yu
authors.forename: Fu-Yuan
authors.initials: FY
authors.lastname: Huang
mesh_terms: D016550:Birthing Centers / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D019992:Databases as Topic; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006801:Humans; D009313:National Health Programs / Q000706:statistics & numerical data; D011247:Pregnancy; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*