title: Obstetric interventions in two groups of hospitals in Catalonia: a cross-sectional study.
abstract: BACKGROUND
  Childbirth assistance in highly technological settings and existing variability in the interventions performed are cause for concern. In recent years, numerous recommendations have been made concerning the importance of the physiological process during birth. In Spain and Catalonia, work has been carried out to implement evidence-based practices for childbirth and to reduce unnecessary interventions.To identify obstetric intervention rates among all births, determine whether there are differences in interventions among full-term single births taking place in different hospitals according to type of funding and volume of births attended to, and to ascertain whether there is an association between caesarean section or instrumental birth rates and type of funding, the volume of births attended to and women's age.
  
  
  METHODS
  Cross-sectional study, taking the hospital as the unit of analysis, obstetric interventions as dependent variables, and type of funding, volume of births attended to and maternal age as explanatory variables. The analysis was performed in three phases considering all births reported in the MBDS Catalonia 2011 (7,8570 births), full-term single births and births coded as normal.
  
  
  RESULTS
  The overall caesarean section rate in Catalonia is 27.55% (CI 27.23 to 27.86). There is a significant difference in caesarean section rates between public and private hospitals in all strata. Both public and private hospitals with a lower volume of births have higher obstetric intervention rates than other hospitals (49.43%, CI 48.04 to 50.81).
  
  
  CONCLUSIONS
  In hospitals in Catalonia, both the type of funding and volume of births attended to have a significant effect on the incidence of caesarean section, and type of funding is associated with the use of instruments during delivery.
authors.affiliation: Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Pompeu Fabra University, Travessera de les Corts, 131-159, Pavelló Ave Maria, Barcelona, 08028, Spain. rescuriet@catsalut.cat.
authors.forename: Ramón
authors.initials: R
authors.lastname: Escuriet
authors.forename: María
authors.initials: M
authors.lastname: Pueyo
authors.forename: Herminia
authors.initials: H
authors.lastname: Biescas
authors.forename: Cristina
authors.initials: C
authors.lastname: Colls
authors.forename: Isabel
authors.initials: I
authors.lastname: Espiga
authors.forename: Joanna
authors.initials: J
authors.lastname: White
authors.forename: Xavi
authors.initials: X
authors.lastname: Espada
authors.forename: Josep
authors.initials: J
authors.lastname: Fusté
authors.forename: Vicente
authors.initials: V
authors.lastname: Ortún
mesh_terms: D000293:Adolescent; D000328:Adult; D001723:Birth Rate / Q000639:trends; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D055815:Young Adult
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