Cesarean delivery rates among family physicians versus obstetricians: a population-based cohort study using instrumental variable methods.

Cesarean delivery rates among family physicians versus obstetricians: a population-based cohort study using instrumental variable methods. CMAJ Open. 2017 Dec 11;5(4):E823-E829 Authors: Dawe RE, Bishop J, Pendergast A, Avery S, Monaghan K, Duggan N, Aubrey-Bassler K Abstract BACKGROUND: Previous research suggests that family physicians have rates of cesarean delivery that are lower than or equivalent to those for obstetricians, but adjustments for risk differences in these analyses may have been inadequate. We used an econometric method to adjust for observed and unobserved factors affecting the risk of cesarean delivery among women attended by family physicians versus obstetricians. METHODS: This retrospective population-based cohort study included all Canadian (except Quebec) hospital deliveries by family physicians and obstetricians between Apr. 1, 2006, and Mar. 31, 2009. We excluded women with multiple gestations, and newborns with a birth weight less than 500 g or gestational age less than 20 weeks. We estimated the relative risk of cesarean delivery using instrumental-variable-adjusted and logistic regression. RESULTS: The final cohort included 776 299 women who gave birth in 390 hospitals. The risk of cesarean delivery was 27.3%, and the mean proportion of deliveries by family physicians was 26.9% (standard deviation 23.8%). The relative risk of cesarean delivery for family physicians versus obstetricians wa...
Source: cmaj - Category: General Medicine Authors: Tags: CMAJ Open Source Type: research