Effects of obstetrician characteristics on cesarean delivery rates: A community hospital experience

Poma, Pedro A.

doi:10.1016/s0002-9378(99)70021-9

Cited by 37 publications

(20 citation statements)

References 18 publications

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“…This result deserves more in-depth qualitative research on such differences. Various studies indicate the effects of obstetrician's characteristics on type of delivery 10,11,30,31,32,33 , but we found only two 34,35 with an independent association between male gender and increased odds of cesarean.…”

Section: Discussioncontrasting

confidence: 71%

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

et al. 2006

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Brazil has one of the world's highest cesarean section rates. Contributing factors include the organization of obstetric practice, physicians' attitudes, and women's preferences and decisions. This study aimed to identify factors associated with cesarean sections in a public maternity hospital in Rio de Janeiro. A case-control study was conducted with 231 cesarean sections (cases) and 230 vaginal deliveries (controls). Hierarchical logistic regression analysis was performed, based on a conceptual model. Factors associated with increased odds of cesarean section were: primiparity; mother's age 20-34; last birth by cesarean; cervical dilatation < 3cm at admission; patient request; daytime birth; male attending obstetrician; obstetrician on duty for more than 24 hours a week; obstetrician with private practice; gestational hypertension; non-cephalic presentation; and gestational age > 41 weeks. Factors associated with lower odds of cesarean were: gestational age < 37 weeks; leaving home with signs of labor, use of oxytocin; and amniotomy. In this hospital, interventions aimed to modify the above-mentioned factors can help lower the cesarean rate.

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Section: Discussioncontrasting

confidence: 71%

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

et al. 2006

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“…It has been suggested that group practices are associated with lower cesarean rates than solo provider practices. 17,18 Indeed, in this study, there was a higher odds of cesarean among patients managed by providers in solo private practice compared to those managed by providers in group private practice (aOR =1.43, p<0.001). One hypothesis for this observation is that larger group practices are more likely to have operational elements that are associated with lower cesarean rate, such as lower frequency of night calls, the ability to obtain second opinions, the implementation of systematic protocols, and having quality assurance programs.…”

Section: Discussionmentioning

confidence: 50%

Two practice models in one labor and delivery unit: association with cesarean delivery rates

Nijagal¹,

Kuppermann²,

Nakagawa³

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective To examine the association between labor and delivery practice model and cesarean delivery rates at a community hospital. Methods This was a retrospective cohort study of 9,381 singleton live births at one community hospital, where women were provided labor and delivery care under one of two distinct practice models: a traditional “private” practice model and a midwife-physician “laborist” practice model. Cesarean rates were compared by practice model, adjusting for potential sociodemographic and clinical confounders. Statistical comparisons were performed using the chi square test and multivariable logistical regression. Results Compared with women managed under the midwife/laborist model, women in the private model were significantly more likely to have a cesarean delivery (31.6% vs 17.3%, p<0.001; adjusted odds ratio [aOR] 2.11, 95% confidence interval [CI] 1.73-2.58). Women with nulliparous, term, singleton, vertex (NTSV) gestations also were more likely to have a cesarean delivery if they were cared for in the private model (29.8% versus 15.9%, p<0.001; aOR 1.86, 95% CI 1.33-2.58) as were women who had a prior cesarean delivery (71.3% versus 41.4%, p<0.001; aOR 3.19, 95% CI 1.74-5.88). Conclusion In this community hospital setting, a midwife-physician laborist practice model was associated with lower cesarean rates than a private practice model.

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“…In the UK as well, the National Institute for Clinical Excellence is developing guidelines to limit the CS rate 19 . Several authors have highlighted the importance of the physician factor in the CS decision and have shown that there is wide variation in the caesarean delivery rate among obstetricians, independent of maternal and infant risk factors 20,21 . However, our study demonstrates that curbing the continuous rise of CS deliveries is difficult to achieve, even when the mode of delivery is based on strictly medical criteria.…”

Section: Discussionmentioning

confidence: 75%

Current caesarean delivery rates and indications in a major public hospital in northern Greece

Dinas

Mavromatidis

Dovas

et al. 2008

Aust NZ J Obst Gynaeco

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Effects of obstetrician characteristics on cesarean delivery rates: A community hospital experience

Cited by 37 publications

References 18 publications

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

Two practice models in one labor and delivery unit: association with cesarean delivery rates

Current caesarean delivery rates and indications in a major public hospital in northern Greece

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