title: Comparison of obstetric outcomes between on-call and patients' own obstetricians.
abstract: BACKGROUND
  The question "will you be delivering my baby?" is one that pregnant women frequently ask their physicians. We sought to determine whether obstetric outcomes differed between women whose babies were delivered by their own obstetrician (regular-care obstetrician) and those attended by an on-call obstetrician who did not provide antenatal care.
  
  
  METHODS
  We performed a cohort study of all live singleton term births between 1991 and 2001 at the Royal Victoria Hospital in Montréal. We excluded breech deliveries, elective cesarean sections and deliveries with placenta previa or prolapse of the umbilical cord. Logistic regression analysis was used to compare obstetric outcomes (e.g., cesarean delivery, instrumental vaginal delivery and episiotomy) between the regular-care and on-call obstetricians after adjustment for potential confounders.
  
  
  RESULTS
  A total of 28,332 eligible deliveries were attended by 26 obstetricians: 21,779 (76.9%) by the patient's own obstetrician and 6553 (23.1%) by the on-call obstetrician. Compared with women attended by their regular-care obstetrician, those attended by an on-call obstetrician had higher rates of cesarean delivery (11.9% v. 11.4%, adjusted odds ratio [OR] 1.13, 95% confidence interval [CI] 1.03-1.24, p < 0.01) and of third-or fourth-degree tears (7.9% v. 6.4%, adjusted OR 1.21, 95% CI 1.07-1.36, p < 0.01) but lower rates of episiotomy (38.5% v. 42.9%, OR 0.77, 95% CI 0.72-0.82, p < 0.001). No differences were observed between the groups in the rate of instrumental vaginal delivery. The increase in the overall rate of cesarean delivery among women attended by an on-call obstetrician was due mainly to an increase in cesarean deliveries during the first stage of labour because of nonreassuring fetal heart tracing (2.9% v. 1.7%, adjusted OR 1.79, 95% CI 1.49-2.15, p < 0.001). The time of day of delivery did not modify the observed effects.
  
  
  CONCLUSIONS
  The type of attending obstetrician (regular care v. on call) had a minor effect on obstetric outcomes.
authors: Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montréal, Que. haim.abenhaim@gmail.com
authors: Haim A
authors: HA
authors: Abenhaim
authors: Alice
authors: A
authors: Benjamin
authors: Robert D
authors: RD
authors: Koby
authors: Robert A
authors: RA
authors: Kinch
authors: Michael S
authors: MS
authors: Kramer
mesh_terms: D002585:Cesarean Section; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009774:Obstetrics; D010817:Physician-Patient Relations; D011247:Pregnancy; D011295:Prenatal Care; D011787:Quality of Health Care
references: J Surg Res. 2004 Dec;122(2):162-6
references: 15555613
references: Int J Health Care Qual Assur Inc Leadersh Health Serv. 2004;17(7):394-400
references: 15552395
references: Laryngoscope. 2005 Jan;115(1):143-6
references: 15630383
references: Clin Exp Obstet Gynecol. 2004;31(4):289-92
references: 15672970
references: Best Pract Res Clin Anaesthesiol. 2005 Mar;19(1):1-16
references: 15679055
references: Obstet Gynecol. 2005 Apr;105(4):751-6
references: 15802401
references: Conn Med. 2005 Mar;69(3):139-41
references: 15861999
references: Obstet Gynecol. 2005 May;105(5 Pt 1):1031-8
references: 15863541
references: JAMA. 2005 May 4;293(17):2141-8
references: 15870418
references: Am J Obstet Gynecol. 2005 Jun;192(6):1820-6; discussion 1826-8
references: 15970818
references: Obstet Gynecol. 2005 Jul;106(1):151-5
references: 15994631
references: J Clin Anesth. 2004 Sep;16(6):411-4
references: 15567643
references: Obstet Gynecol. 2000 Apr;95(4):616-8
references: 10725500
references: Cochrane Database Syst Rev. 2000;(2):CD000081
references: 10796120
references: J Perinat Med. 2000;28(2):111-7
references: 10875095
references: Am J Med Sci. 2002 Oct;324(4):212-9
references: 12385494
references: J Reprod Med. 2004 Mar;49(3):143-7
references: 15098882
references: Inquiry. 2004 Summer;41(2):170-88
references: 15449432
references: J Matern Fetal Neonatal Med. 2004 Aug;16(2):115-8
references: 15512722
references: N Engl J Med. 1986 Sep 4;315(10):619-24
references: 3736601
references: Invest Radiol. 1993 Jan;28(1):92-6
references: 8425860
references: J Reprod Med. 1995 Feb;40(2):101-6
references: 7738918
references: N Engl J Med. 1995 Oct 12;333(15):953-7
references: 7666913
references: Am J Obstet Gynecol. 1997 Sep;177(3):599-605
references: 9322630
references: J Health Econ. 1999 Aug;18(4):491-522
references: 10539619