P A Poma1. 1. Department of Obstetrics and Gynecology, Ravenswood Hospital Medical Center, Chicago, Illinois, USA.
Abstract
OBJECTIVE: Despite a decrease in the overall cesarean delivery rate at Ravenswood Hospital Medical Center in Chicago, a wide range of variation existed among individual obstetricians' rates. This study evaluated obstetricians' characteristics to determine whether they affected cesarean delivery rates. STUDY DESIGN: In 1994 members of my department adopted strategies to decrease the cesarean delivery rate. Data on women who were delivered at the obstetric unit from 1994-1997 and data on their neonates were studied. Certain characteristics of obstetricians were also analyzed. The data were grouped according to personal characteristics and obstetricians' cesarean delivery rates: group 1 had a low rate (</=15%) and group 2 had a high rate (>15%). Pearson chi2 analysis was used to evaluate the differences between the proportions. P <.05 was considered significant. RESULTS: The departmental cesarean delivery rate decreased from 20.5% in 1994 to 15.5% in 1997 (P <.0001), whereas individual obstetricians' rates varied from 0% to 44.4%. Obstetricians in group 1 (average rate 12.2%) and group 2 (average rate 20.8%, P <.0001) served similar populations with similar outcomes. Compared with obstetricians in group 2, those in group 1 (low rate) performed more vaginal deliveries after cesarean birth and used epidural analgesia and the vacuum extractor more frequently. Young age of physician, graduation from a domestic medical school, group practice, and smaller volume of births were all significantly linked to lower cesarean delivery rates. CONCLUSIONS: Cesarean delivery rates can safely be reduced. Certain individual obstetrician characteristics influence cesarean delivery rates. Obstetricians' commitment facilitates lowering of cesarean delivery rates.
OBJECTIVE: Despite a decrease in the overall cesarean delivery rate at Ravenswood Hospital Medical Center in Chicago, a wide range of variation existed among individual obstetricians' rates. This study evaluated obstetricians' characteristics to determine whether they affected cesarean delivery rates. STUDY DESIGN: In 1994 members of my department adopted strategies to decrease the cesarean delivery rate. Data on women who were delivered at the obstetric unit from 1994-1997 and data on their neonates were studied. Certain characteristics of obstetricians were also analyzed. The data were grouped according to personal characteristics and obstetricians' cesarean delivery rates: group 1 had a low rate (</=15%) and group 2 had a high rate (>15%). Pearson chi2 analysis was used to evaluate the differences between the proportions. P <.05 was considered significant. RESULTS: The departmental cesarean delivery rate decreased from 20.5% in 1994 to 15.5% in 1997 (P <.0001), whereas individual obstetricians' rates varied from 0% to 44.4%. Obstetricians in group 1 (average rate 12.2%) and group 2 (average rate 20.8%, P <.0001) served similar populations with similar outcomes. Compared with obstetricians in group 2, those in group 1 (low rate) performed more vaginal deliveries after cesarean birth and used epidural analgesia and the vacuum extractor more frequently. Young age of physician, graduation from a domestic medical school, group practice, and smaller volume of births were all significantly linked to lower cesarean delivery rates. CONCLUSIONS: Cesarean delivery rates can safely be reduced. Certain individual obstetrician characteristics influence cesarean delivery rates. Obstetricians' commitment facilitates lowering of cesarean delivery rates.
Authors: Aluísio J D Barros; Iná S Santos; Alicia Matijasevich; Marlos Rodrigues Domingues; Mariângela Silveira; Fernando C Barros; Cesar G Victora Journal: Rev Saude Publica Date: 2011-06-10 Impact factor: 2.106