Abstract
Pattern of hospital delivery in Thailand 1990-1996There is no comprehensive information of the pattern of hospital delivery in Thailand. The Ministry of Public Health (MOPH) statistics only report normal and abnormal deliveries. Non-MOPH and other private hospital information is totally lacking. The objective of this study is to demonstrate the pattern of hospital delivery in Thailand during the period of 1990-96. Questionnaire survey to all public and private hospital was done with a result of 62 percent response rate. Important parameters include total hospital deliveries, mode of delivery (vaginal, cesarean, vacuum, forceps and others), primary or secondary cesarean, and number of full and part time obstetricians in each hospital during the period of 1990-96. The following results are very interesting. 1.MOPH distric and provincial hospitals got a lion share, 67 percent of total national hospital deliveries. Private hospital delivery is less common, only 9 percent of totals. 2.In 1996, cesarean rate in distric hospitals was percent 7.2, provincial hospitals percent 22.9, other public hospitals percent 21.2 and private hospitals 51.5 percent. The national cesarean rate was 22.4 percent. 3.In 1996, vaginal birth rate was 67 percent, other type of delivery 11 percent. During 7 years (1990-96), vaginal birth rate gradually decreased, cesarean rate gradually increase and forceps and vacuum extraction stays constant at 10-11 percent of total hospital deliveries. 4.Cesarean rate steadily increased from 15.2 percent in 1990 to 22.4 percent in 1996 and showed a further increasing trend. 5.In 1996, of the total cesarean cases, 64.1 percent was primary and 35.9 percent was secondary cesarean (indicating previous cesarean). 6.In district hospitals, cesarean rate in 1996 was 7.2 percent , of which 5.5 percent was primary and 1.7 percent was secondary sections. Primary rate increased at a higher rate than secondary in the past seven years. 7. In provincial hospitals, cesarean rate in 1996 was 23 percent, of which 14.4 percent was primary and 8.5 percent was secondary sections. Secondary rate significantly increased at a higher rate than secondary in the past seven years. 8.In other public hospitals, cesarean rate in 1996 was 21 percent, of which 14.1 percent was primary and 7.1 percent was secondary sections. Primary and secondary rate has similar rate of increase in the past seven years. 9.In private hospitals, cesarean rate in 1996 was 51.4 percent, of which 32 percent was primary and 19.4 percent was secondary sections. Primary rate increased at a higher rate than secondary in the past seven years. 10.The national average, cesarean section rate increased from 15.2 percent to 22.4 percent during the seven years. Primary and secondary rate has similar pace of increase. 11.The number of obstetricians in sample hospitals increased from 648 in 1990 to 882 in 1996, a 36 percent increase. At the same time, number of cesarean childbirths increased from 58,183 cases in 1990 to 109,867 cases in 1996, a 89 percent increase in the same perid. 12.Casarean surgery workload per obstetrician increased from 88 cases per year in 1990 to 121 cases in 1996.
