THE IMPACT OF SPECIALTY ON CESAREAN SECTION RATES

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It has been recognized that non-clinical factors such as a patient's socio-economic status, the type of clinic where she receives her prenatal care, and whether she is delivered by an attending obstetricians or a resident influence the likelihood that she will be delivered by Cesarean section. There is also some suggestion that the specialty of the physician from whom she receives her care will influence the type of delivery she receives. Specifically, family physicians who are trained in "family centered" obstetrics rather than surgical care have been observed in pilot studies in Michigan and Kentucky to deliver their patients by Cesarean section at a rate one- third less for obstetricians in the same facilities when patients of the two specialties are matched for risk factors. This study will expand on the hypothesis that Cesarean section rates differ for family physicians and obstetricians by examining physician specialty along with other variables which are known to influence cesarean section rates in a retrospective multi-site study. Institutions from the northeast, midwest, and south will review obstetric records for the four year period of January, 1988 through December, 1991 and the route of delivery will be examined for physicians of each specialty. Using multivariate analysis of variance, physician specialty will be compared with other demographic and clinical factors that may influence Cesarean section rates. Additionally, maternal and neonatal outcomes will be compared for patients of varying risk status between the two specialties to determine if physician specialty influences the quality of obstetric care. Since the training of family physicians and obstetricians differs significantly, differences in Cesarean section rates between the two specialties may suggest alterations in the training of physicians which may be useful in curtailing the recent rapid rise in national Cesarean section rates. Alternatively, differences in Cesarean section rates between the two specialties may reflect selection bias by patients such that patients whose expectations and attitudes favor a Cesarean section are more likely to select a particular specialist for their obstetric care. Further research into the attitudes and expectations of patients and how these attributes influence obstetric care would also be useful.