Although quality assessment of an obstetric service involves much more than just reporting operative delivery and perinatal mortality rates (Chapter 28), all care providers within one institution should know the institutional intervention and outcome data. An effective initiative to rekindle professionals’ desire to have a good spontaneous delivery rate is provision of each obstetrician with his/her individual operative delivery rates on a regular basis. But in comparisons the populations must be comparable. Some obstetricians will complain that their intervention rates are relatively high because of their “skewed population” with a higher proportion of multiple gestations, breech presentations, and patients with complicated diabetes, early-onset preeclampsia, HIV, etc. These conditions will have to be verified and taken into account when comparing overall intervention rates between doctors.

Problems and pitfalls in inter-hospital comparisons

Unfortunately, there still is a lack of standardized information allowing meaningful comparisons of hospital annual reports. Operative delivery rates may be affected by several demographic, obstetric, and fetal factors, as well as childbirth-system related issues – such as whether hospitals cover the entire regional pregnant population or only a part because of out-of-hospital deliveries attended by independent midwives. These factors are beyond the control of obstetricians and for this reason the “raw” cesarean birth rate of a hospital is unsuitable for assessing the labor and delivery skills of its birth professionals. To complicate matters further, hospital year reports vary widely in patient stratification.