Abstract
A previous study has shown a marked and continuing decline in weekend births in Germany between 1988 and 2003 (Lerchl, Naturwissenschaften 92:592–594, 2005). The present study was performed to investigate the possible influence of caesarean sections (CS) on weekend birth number and on the involvement of midwives in births for all 16 German states for the year 2003. In total, data from 706,721 births were sorted according to weekday of births and state, respectively, and the weekend births avoidance rates were calculated. Weekend births were consistently less frequent than births during the week, with an average of −15.3% for all states and due to fewer births on Saturdays (−13.6%) and Sundays (−16.7%). Between the states, weekend births avoidance rates ranged from −11.6% (Bremen) to −24.2% (Saarland). The proportion of CS was 25.5% for all states, ranging from 19.2% (Sachsen and Sachsen-Anhalt) to 30.5% (Saarland). CS and weekend births avoidance rates were significantly correlated, consistent with the hypothesis that primary (planned) CS are regularly scheduled on weekdays. The number of births per midwife (BPM) was calculated according to the number of active members in the states’ professional midwives’ organizations. The mean number of BPM was 59.5, ranging from 45.2 (Bremen) to 82.4 (Sachsen-Anhalt). CS and BPM were significantly correlated, consistent with the hypothesis that higher CS ratios are associated with lower midwife involvement in births. It is concluded that the decline in weekend births and lower involvement of midwives are caused, at least in part, by an increased number of caesarean sections.
References
Agresti A, Caffo B (2000) Simple and effective confidence intervals for proportions and differences of proportions result from adding two successes and two failures. Am Stat 54:280–288
Black C, Kaye JA, Jick H (2005) Cesarean delivery in the United Kingdom: time trends in the general practice research database. Obstet Gynecol 106:151–155
Buhimschi CS, Buhimschi IA (2006) Advantages of vaginal delivery. Clin Obstet Gynecol 49:167–183
Diniz SG, Chacham AS (2004) “The cut above” and “the cut below”: the abuse of caesareans and episiotomy in Sao Paulo, Brazil. Reprod Health Matters 12:100–110
Goldstick O, Weissman A, Drugan A (2003) The circadian rhythm of “urgent” operative deliveries. Isr Med Assoc J 5:564–566
Goodman MJ, Nelson WW, Maciosek MV (2005) Births by day of week: a historical perspective. J Midwifery Womens Health 50:39–43
Gould JB, Qin C, Marks AR, Chavez G (2003) Neonatal mortality in weekend vs weekday births. JAMA 289:2958–2962
Hakansson S, Kallen K (2003) Caesarean section increases the risk of hospital care in childhood for asthma and gastroenteritis. Clin Exp Allergy 33:757–764
Hendry RA (1981) The weekend—a dangerous time to be born? Br J Obstet Gynaecol 88:1200–1203
Kozak LJ, Owings MF, Hall MJ (2005) National Hospital Discharge Survey: 2002 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13:1–199
Lerchl A (2005) Where are the Sunday babies? Observations on a marked decline in weekend births in Germany. Naturwissenschaften 92:592–594
Lerchl A, Reinhard S (2007) Where are the Sunday babies? II. Declining weekend birth rates in Switzerland. Naturwissenschaften (this issue). http://dx.doi.org/10.1007/s00114-007-0305-4
Liu S, Rusen ID, Joseph KS, Liston R, Kramer MS, Wen SW, Kinch R (2004) Recent trends in caesarean delivery rates and indications for caesarean delivery in Canada. J Obstet Gynaecol Can 26:735–742
MacFarlane A (1978) Variations in number of births and perinatal mortality by day of week in England and Wales. Br Med J 2:1670–1673
Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML (2003) Births: final data for 2002. Natl Vital Stat Rep 52:1–113
Martin JA, Kochanek KD, Strobino DM, Guyer B, MacDorman MF (2005) Annual summary of vital statistics—2003. Pediatrics 115:619–634
Mathers CD (1983) Births and perinatal deaths in Australia: variations by day of week. J Epidemiol Community Health 37:57–62
Mossialos E, Allin S, Karras K, Davaki K (2005) An investigation of caesarean sections in three Greek hospitals: the impact of financial incentives and convenience. Eur J Public Health 15:288–295
Oladapo OT, Sotunsa JO, Sule-Odu AO (2004) The rise in caesarean birth rate in Sagamu, Nigeria: reflection of changes in obstetric practice. J Obstet Gynaecol 24:377–381
Renz-Polster H, David MR, Buist AS, Vollmer WM, O’Connor EA, Frazier EA, Wall MA (2005) Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy 35:1466–1472
Schwarz CM, Schücking BA (2004) Adieu normale Geburt? Ergebnisse eines Forschungsprojekts. Dr Med Mabuse 148:22–25
Signorelli C, Ferdico M, Cattaruzza MS, Osborn JF (1991) Indications for caesarean section: results of a local study. Ann Ostet Ginecol Med Perinat 112:15–19
Simpson KR, Atterbury J (2003) Trends and issues in labor induction in the United States: implications for clinical practice. J Obstet Gynecol Neonatal Nurs 32:767–779
Simpson KR, Thorman KE (2005) Obstetric “conveniences”: elective induction of labor, cesarean birth on demand, and other potentially unnecessary interventions. J Perinat Neonatal Nurs 19:134–144
Wagner M (2001) Fish can’t see water: the need to humanize birth. Int J Gynaecol Obstet 75(Suppl 1):S25–S37
ZQG (2004) Zentrum für Qualitätsmanagement im Gesundheitswesen: Qualitätsbericht Geburtshilfe Jahresauswertung 2004.
Acknowledgments
I wish to thank the following persons for help: Barbara Rösel, Statistisches Landesamt Bremen; Prof. Adalbert Wilhelm, Jacobs University; Dr. Lothar Baumann, Statistisches Landesamt Baden-Württemberg; Rainhild Schäfers, Bund Deutscher Hebammen, Münster, and AOK-Bundesverband, Bonn.
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Lerchl, A. Where are the Sunday babies? III. Caesarean sections, decreased weekend births, and midwife involvement in Germany. Naturwissenschaften 95, 165–170 (2008). https://doi.org/10.1007/s00114-007-0306-3
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DOI: https://doi.org/10.1007/s00114-007-0306-3