title: Analyzing the impact of private service on the cesarean section rate in public hospital Thailand.
abstract: OBJECTIVE
  To assess the cesarean section rate and compare the risk profiles of cesarean delivery in nulliparous women between private and non-private service.
  
  
  METHODS
  The computerized delivery records, collected from June 2006 to May 2009 at Rajavithi Hospital were retrospectively reviewed. Of these, 11,049 term singleton nulliparous pregnant women without maternal chronic medical disease were divided into two groups; private and non-private group. Demographic data, cesarean section rate, indication for cesarean section, time of delivery, maternal and neonatal outcomes were assessed and analyzed.
  
  
  RESULTS
  The cesarean section rate was markedly different between both groups. The cesarean rates of all pregnant women, women in private group and non-private group were 25.7% (2,841 out of 11,049), 67.3% (1,187 out of 1,765), and 17.8% (1,654 out of 9,284), respectively. The private group's odds of having a cesarean delivery was 9.44 times [95% confidence interval (95% CI) 8.372-10.655] higher than the non-private group's after adjusting for background differences (maternal age, race, gestational age and birth weight). The most common indications for cesarean delivery in private group were elderly gravida, unfavorable cervix and cephalopelvic disproportion. The private group had significantly higher operation rate in the office hours than that of non-private group (70.1 vs. 41.8%; p < 0.0001). After adjusted for background differences, postpartum hemorrhage was significant higher in private group. Conversely, there was fewer admission to neonatal intensive care unit in private group. Low Apgar score at 5 min and perinatal death were not statistically significant in both groups. No cesarean hysterectomy and maternal death in both groups were noted.
  
  
  CONCLUSIONS
  Private patients had a significantly higher rate of cesarean section than non-private patients. NICU admission was significantly lower in the private group, but postpartum hemorrhage was significantly higher. There were no significant differences in maternal mortality, low Apgar score at 5 min, perinatal death in both group. This study suggests that a significant number of cesarean sections among private services may be unnecessary. To safely reduce a cesarean section rate, an appropriate policy and guideline for auditing cesarean section among private service should be developed.
authors.affiliation: Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok 10400, Thailand. Podjaneej@yahoo.com
authors.forename: Podjanee
authors.initials: P
authors.lastname: Phadungkiatwattana
authors.forename: Naiyana
authors.initials: N
authors.lastname: Tongsakul
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006123:Group Practice / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011331:Private Practice / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand; D055815:Young Adult