Mode of delivery trends by hospital type: an 18-year comparison of a military hospital with university and community hospitals.
OBJECTIVE
To determine the rate of mode of delivery over 18 years in a military teaching hospital as compared to university and community hospitals.


METHODS
From January 1992 to December 2009, we retrospectively calculated yearly rates for mode of delivery from a military hospital, two university hospitals, a community hospital in South Carolina and all community hospitals in Arkansas.


RESULTS
Over the 18-year period, 803,249 deliveries occurred from all hospitals. Overall the cesarean delivery rates have significantly increased across all practice models (22.7% + 0.9 versus 33.0% + 0.9, p = <0.001). The rate of increase has been greatest in university hospitals (21.8-37%) followed by community hospitals (26.7-32.9%) and the military hospital (19.6-29.2%). The rate of forceps-assisted deliveries has decreased dramatically across all practice models (11.6% + 1.3 versus 1.1% + 0.1, p = <0.001). The decline in forceps use was 6.4 to 1.1% in community hospital, 12.6 to 1.4% in university hospitals, and 15.7 to 0.9% in military hospitals.


CONCLUSIONS
The overall cesarean delivery rate has increased in all practice models but less so in the military. Forceps deliveries have dramatically decreased overall especially in the military hospital.
Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 029051.
Joshua D
JD
Dahlke
Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205.
Everett F
EF
Magann
Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205.
Tommy M
TM
Bird
Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708.
Jesse
J
Rohloff
Department of Obstetrics and Gynecology, Spartanburg Regional Medical Center, 101 East Wood Street, Spartanburg, SC 29303.
James A
JA
Scardo
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216.
John C
JC
Morrison
D001131:Arkansas; D036861:Delivery, Obstetric / Q000639:trends*; D005260:Female; D006764:Hospitals, Community / Q000639:trends*; D006772:Hospitals, Military / Q000639:trends*; D006785:Hospitals, University / Q000639:trends*; D006801:Humans; D012189:Retrospective Studies; D013022:South Carolina