• J P Elliott, M M Russell, and L A Dickason.
• Phoenix Perinatal Associates, AZ, USA.
• Am. J. Obstet. Gynecol. 1997 Jul 1;177(1):139-43.

ObjectiveOur purpose was to determine the benefits of an acuity-adjusted labor management tool.Study DesignA retrospective review was performed of all deliveries at Good Samaritan Regional Medical Center in Phoenix, Arizona, for a 1-year period from Jan. 1 to Dec. 31, 1994. All physicians with > or = 20 deliveries were included in the analysis. Patients with indications for which most practitioners would perform a cesarean delivery were removed from consideration. Physicians were then compared with respect to labor management in the remaining patients without relative contraindications to vaginal delivery.ResultsThe total number of deliveries (n = 6062) was performed by 47 attending obstetricians, 9 perinatologists, an obstetrics-gynecology clinic, and a family practice clinic. The "raw" cesarean section rate was 20.1%. Those at high risk for cesarean delivery (n = 534) were excluded, leaving 684 cesarean sections performed in 5528 patients (12.4%) who were appropriate to labor. Differences were observed between the nulliparous cesarean section rate (16%) compared with that for parous patients (10.1%) (p < 0.0001 by Fisher's exact test (two-tailed) but not between attending obstetrician-gynecologists (12.4%) and perinatologists (13.8%) (not significant).ConclusionA labor-adjusted cesarean section rate is more appropriate than just "raw" data. Medical, obstetric, and fetal factors affect a "raw" rate that is out of the control of the obstetrician. This method of assessing the labor and delivery skills of each practitioner and hospital would allow meaningful comparison with others.

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