The “Proportion of deliveries by primary cesarean section” is an indicator that can be used to assess the quality of care provided to mothers giving birth. Hospitals and health systems are often compared based on this indicator, since lower values may reflect more appropriate clinical practice and that some cesarean sections may be performed for “non-medical reasons.”Data show a slight reduction in the proportion of deliveries by primary cesarean section in Italy from 2015 (25%) to 2021 (22%).
The Ministry of Health Decree No. 70 of April 2, 2015, on hospital care standards establishes a maximum threshold for the proportion of primary cesarean sections that varies based on the type of hospital, but which must not exceed 25%. Comparisons between hospitals could, however, be distorted if the possible different distribution of patient risk factors for cesarean section were not taken into account. C-sections are indicated in many clinical situations, such as placental or cord complications, fetal distress, HIV infection, and fetal-pelvic disproportion.
Furthermore, sociodemographic differences or differences in the availability of services for high-risk pregnancies increase the likelihood of a cesarean section. The primary cesarean section indicator is calculated as the proportion of a woman’s first cesarean section births.
Since women with a previous cesarean birth are less likely to give birth vaginally, the indicator “Proportion of vaginal births in women with a previous cesarean birth” was calculated separately.This indicator measures vaginal births performed in a hospital setting among women who have previously given birth by cesarean section.
Data shows a rate of vaginal births after previous cesarean sections of around 10.5% between 2018 and 2021.
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Indicators 
