Cesarean section rates among health professionals in Finland, 1990-2006

Objective. The purpose of this paper is to establish whether health professionals in Finland have cesarean sections more or less often than other women of a similar educational background. Design. Register-based study (Finnish birth register). Setting. Finland 1990-2006. Population. Singleton births, for midwives (3,009 births), nurses (101,199), and physicians (7,642). Teachers (n=23,454) were chosen as controls for midwives and nurses, and other white collar workers (n=124,606) were chosen as controls for physicians. Methods. Cesarean section rates were studied for all births and for first births only. The odds ratios for mode of delivery were calculated using logistic regression, adjusting for age, parity, marital status and smoking, and in an additional analysis, also adjusting for post-term birth and birth weight. Main outcome measures. Mode of delivery. Results. During the time period studied, the overall cesarean section rate in Finland was 15%. The studied groups had similar rates of cesarean section. When adjusting for background characteristics, midwives and nurses had marginally lower cesarean section rates than teachers, and physicians had lower rates than other white collar workers. In the case of first births, similar differences were found. Instrumental deliveries were somewhat lower among midwives as compared to teachers, and among physicians as compared to other white collar workers. Conclusions. Our results suggest that Finnish physicians may prefer vaginal delivery and have relatively conservative opinions about cesarean sections. This may be an important explanation of the relatively low, compared to international rates, and stable cesarean section rates in Finland.