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International Journal for Quality in Health Care 8:159-165 (1996)
© 1996 International Society for Quality in Health Care

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Are Operative Delivery Procedures in Greece Socially Conditioned?

YANNIS SKALKIDIS*, ELENI PETRIDOU*,{dagger}, EUGENIA PAPATHOMA*, KATHARINE REVINTHI*, DONALD TONG{dagger} and DIMITRIOS TRICHOPOULOS{dagger}

*Department of Hygiene and Epidemiology, University of Athens Medical School Goudi, 115–27 Athens, Greece
{dagger}Department of Epidemiology, Harvard School of Public Health 677 Huntingdon Avenue, Boston, MA 02115, USA

Caesarean section rates have increased in Greece by almost 50% during the last 13 years. We conducted a study in Athens, Greece, to assess the importance of a series of medical and socioeconomic factors in the use of Caesarean section or operative vaginal procedures, rather than a non-operative process, for the delivery of singleton, liveborn babies of primiparous mothers. We used a case control approach to compare 444 babies delivered through a Caesarean section and 130 delivered through operative vaginal delivery with 1235 normally delivered babies in a public and a private hospital. Data were analysed through multiple logistic regression. Caesarean section was more commonly performed in older, shorter or overweight mothers and for high and low birth-weight babies, as well as in response to several obstetric complications and following in-vitro fertilization. A similar pattern was noted with respect to operative vaginal delivery, except that this procedure was not unusually frequent among overweight women and was not encountered in this study among children born after in-vitro fertilization. Caesarean section was performed twice as often in the public teaching hospital as in a private maternity hospital, and operative vaginal delivery was several times more common in the former than in the latter, after controlling for biomedical risk factors. The unequal distribution of operative delivery procedures between the public and the private hospital raises questions about the justification of their performance in a substantial fraction of deliveries, and indicates that social factors condition their use. Copyright © 1996 Elsevier Science Ltd.

Keywords: Caesarean section, operative vaginal delivery, risk factors, time trends, public vs. private hospital delivery

Eleni Petridou, Department of Hygiene and Epidemiology, University of Athens Medical School, Goudi, 115–27 Athens, Greece. Tel. and Fax: (301) 777 3840.

Received for publication November 7, 1995.
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E. Mossialos, S. Allin, K. Karras, and K. Davaki
An investigation of Caesarean sections in three Greek hospitals: The impact of financial incentives and convenience
Eur J Public Health, June 1, 2005; 15(3): 288 - 295.
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