Cesarean Delivery Outcomes for Rural FPs and Obstetricians

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´╗┐Cesarean Delivery Outcomes for Rural FPs and Obstetricians

Abstract and Introduction

Abstract


Purpose: Despite declining access to obstetrical care in many regions, family physicians often have difficulty obtaining Cesarean delivery privileges. We compared outcomes of Cesarean deliveries performed by family physicians (FPs) and obstetricians (OBs). The last such study done was more than 15 years ago.

Methods: This study was a chart review of 250 consecutive Cesarean deliveries was done at 2 rural New England hospitals. At one hospital, Cesarean deliveries were performed by FPs; at the other they were done by OBs. Demographics, pregnancy risk factors, and maternal and neonatal complication rates at each site were compared.

Results: Demographics, indications for Cesarean delivery, and prenatal risk factors were comparable at both sites except there were more hypertensive patients at the FP site. There were no differences in intraoperative or infectious complications. There were fewer postoperative complications at the FP hospital, which were mostly attributable to fewer blood transfusions and readmissions. There were no differences in neonatal outcomes, although there were more deliveries of fetuses <38 weeks' gestation at the FP site.

Conclusions: Patients did not face increased risk when Cesarean deliveries were performed by FPs rather than OBs. A larger, more geographically diverse study is needed to confirm these findings. Results could support FPs seeking privileges to perform Cesarean deliveries, thus expanding access to care for pregnant women.

Introduction


Literature comparing outcomes of Cesarean delivery when performed by family doctors compared with obstetricians is limited and dated. The last such study was published 17 years ago, using data collected as far back as 1980. In some countries, such as Canada, and in some geographic areas of the United States, Cesarean deliveries are commonly performed by family physicians. Nationwide, 9.3% of family doctors perform Cesarean deliveries, 4.4% independently and 4.9% in consultation with obstetrics. However, well-trained family physicians report having difficulty securing hospital privileges to do Cesarean deliveries. Credentials can be granted or restricted based on committee members' personal opinions, without consideration of physicians' training and experience or scientific data (K. Marvin and L. Desang, personal communications).

Accordingly, the number of family physicians who perform Cesarean deliveries has decreased steadily. In addition, for a variety of reasons, including malpractice rates and changes in reimbursement, availability of obstetricians in many underserved areas of the United States also has declined. In the northern part of the state of New Hampshire, for example, there are currently no hospitals providing obstetric services (A. Alley, personal communication). A study that proved the safety of Cesarean deliveries when performed by family doctors could provide support to family physicians seeking Cesarean delivery privileges and could thus strengthen the availability of this much needed service to pregnant women in underserved areas. Alternatively, a study that showed concerns about outcomes would be valuable in tailoring and improving the curriculum of family medicine residency and fellowship training programs.

The purpose of this study was to compare the outcomes of Cesarean deliveries at 2 rural New England hospitals, one with family doctors performing Cesarean deliveries (family medicine hospital [FMH]) and the other with obstetricians performing Cesarean deliveries (obstetric hospital [OBH]). The first phase, reported here, is a pilot study in 2 New England community hospitals.

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