Do family physicians 'prevent' cesarean sections? A Canadian exploration.

In Canada the rate of births attended by family physicians has declined in parallel with a rise in cesarean births. This reciprocal association has been most marked in those provinces with a relative abundance of obstetricians, a falling birth rate, and large metropolitan areas. Yet, the perinatal mortality rate, with one exception, is virtually the same in all provinces, both where the obstetricians provide most maternity care and where the family physicians play the dominant role. Thus, societal, environmental, and interprofessional issues have more to do with the rising number of cesarean sections and the decline of family physician-attended births than any objective measurement of quality of care. There is evidence that low-technology, high-continuity approaches for women at no anticipated risk are as safe or safer than the universal application of highly interventive care for all. This paper presents an attempt to determine if the decline in family physician-attended births in Canada is related to the rise in the cesarean section rate.