Effects of obstetrician characteristics on cesarean delivery rates. A community hospital experience.
OBJECTIVE
Despite a decrease in the overall cesarean delivery rate at Ravenswood Hospital Medical Center in Chicago, a wide range of variation existed among individual obstetricians' rates. This study evaluated obstetricians' characteristics to determine whether they affected cesarean delivery rates.


METHODS
In 1994 members of my department adopted strategies to decrease the cesarean delivery rate. Data on women who were delivered at the obstetric unit from 1994-1997 and data on their neonates were studied. Certain characteristics of obstetricians were also analyzed. The data were grouped according to personal characteristics and obstetricians' cesarean delivery rates: group 1 had a low rate (</=15%) and group 2 had a high rate (>15%). Pearson chi2 analysis was used to evaluate the differences between the proportions. P <.05 was considered significant.


RESULTS
The departmental cesarean delivery rate decreased from 20.5% in 1994 to 15.5% in 1997 (P <.0001), whereas individual obstetricians' rates varied from 0% to 44.4%. Obstetricians in group 1 (average rate 12.2%) and group 2 (average rate 20.8%, P <.0001) served similar populations with similar outcomes. Compared with obstetricians in group 2, those in group 1 (low rate) performed more vaginal deliveries after cesarean birth and used epidural analgesia and the vacuum extractor more frequently. Young age of physician, graduation from a domestic medical school, group practice, and smaller volume of births were all significantly linked to lower cesarean delivery rates.


CONCLUSIONS
Cesarean delivery rates can safely be reduced. Certain individual obstetrician characteristics influence cesarean delivery rates. Obstetricians' commitment facilitates lowering of cesarean delivery rates.
Poma
P A
PA
Department of Obstetrics and Gynecology, Ravenswood Hospital Medical Center, Chicago, Illinois, USA.
D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007348:Insurance, Health; D007751:Labor, Induced; D008297:Male; D008423:Maternal Age; D009772:Obstetrical Forceps; D009774:Obstetrics / Q000193:education; D010298:Parity; D010818:Practice Patterns, Physicians'; D011247:Pregnancy