The Green Bay cesarean section study: the physician factor as a determinant of cesarean birth rates

Article Abstract:

The reasons for the increased cesarean section rate in the US are controversial. Some propose that cesarean operations have increased because the procedure reduces fetal and infant complications. Some have also suggested that cesarean rates have increased five-fold since the 1960s because the operation itself has become safer. To help identify factors that influence delivery decisions, and to determine the effect the delivery route has on the pregnancy outcome, 1,030 caesareans performed by 11 obstetricians were studied. The caesareans performed at two Green Bay hospitals from 1986 through 1988 were compared with 1,076 vaginal deliveries. The cesarean delivery rate represented 14 percent of the 7,335 single fetus deliveries during the overall study period. The cesarean rate of individual physicians ranged from 5.6 to 19.7 percent, and the cesarean rate of physician groups ranged from 9.8 to 18 percent. The differences in the cesarean rate between individual physicians and group practices were not related to increased high risk patients, socioeconomic status, service status (clinic or private physician), or the length of time the physician has been in practice. There were no differences between high and low cesarean rate groups with respect to infant well-being at birth (Apgar score), need for neonatal resuscitation, or length of respirator use. Physicians' individual practice style was related to the cesarean section rate. It is thought that this variation is also due to the intense medical-legal climate facing the practice of obstetrics. It appears that cesarean section rates can be lowered without compromising newborn and fetal safety. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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The physician factor as a determinant of cesarean birth rates for the large fetus

Article Abstract:

Larger-than-normal fetuses may have a lower newborn complication rate with vaginal delivery than with cesarean section. Researchers retrospectively evaluated outcomes of 713 infants weighing 4536 grams (about 10 pounds) or more at birth, born over a 10-year period, and compared them to infants with lower birth weights. Vaginal delivery did not increase the risk of newborn or maternal complications among infants weighing 4000 grams or more. About half of the injuries to the brachial plexus area of the neck happened in difficult shoulder deliveries, and most of these injuries went away soon after birth. Obstetricians with a low cesarean section rate had lower newborn complication rates following either vaginal or cesarean delivery than did obstetricians with high rates of cesarean delivery.

Research, Demographic aspects, Fetal macrosomia

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The labor-adjusted cesarean section rate - a more informative method than the cesarean section "rate" for assessing a practitioner's labor and delivery skills

Article Abstract:

It may be more informative to report and compare physicians' and hospitals' cesarean rates using patients with similar risk for delivering vaginally. Different cesarean rates were calculated using medical records of 6,062 deliveries at one hospital over a one-year period. The overall cesarean rate for this hospital was 20.1%. However, when patients known to be at high risk for delivering by cesarean were dropped from the calculation the cesarean rate for this hospital was only 12.4%. First-time mothers were at increased risk for cesareans. Cesarean rates did not differ by physician specialty.

Labor (Obstetrics)

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