Comparing rates of trial of labour attempts, VBAC success, and fetal and maternal complications among family physicians and obstetricians.
OBJECTIVE
To determine differences between family physicians and obstetricians in rates of trial of labour (TOL) attempt, vaginal birth after Caesarean section (VBAC) success, and maternal-fetal complications.


METHODS
We undertook a database evaluation study in an urban Quebec secondary care hospital centre that serves a multiethnic population. Study subjects were pregnant women with at least one previous Caesarean section (CS), who delivered singletons at St. Mary's Hospital Center between January 1995 and December 2003. Outcomes were rates of TOL attempt, of VBAC success and failure, and of uterine rupture or dehiscence.


RESULTS
Of 32 500 singleton deliveries, 3694 (11.4%) women met study criteria. Of these, 3493 (94.6%) were patients of obstetricians, and 201 (5.4%) were patients of family physicians. The TOL attempt rate was 50.6% (1768) and 81.1% (163) for obstetricians and family physicians, respectively (P 0.001). For women having TOL, the VBAC success rate was 64.3% for obstetricians and 76.1% for family physicians (P = 0.002). Rates of uterine rupture or dehiscence in the combined failed and successful VBAC groups were 2.9% for obstetricians and 4.3% for family physicians (P = 0.33) whereas in the failed VBAC group the rates were 7.9% versus 17.9% for the family physicians (P = 0.04). Within delivery outcomes for successful and failed VBAC there were no differences in maternal characteristics and newborn outcomes by physician group.


CONCLUSIONS
More patients of family physicians than of obstetricians attempted TOL and had successful VBAC. Newborn outcomes were similar in the two groups, except that in the failed VBAC group, the family doctors had slightly higher uterine rupture or dehiscence rates; given the low power of this study, further studies are needed to confirm and explain this result. Also, given the similarity in patient profiles, the differences in delivery outcomes may be attributable to differences in physician practice styles.
Russillo
Balbina
B
Department of Family Medicine, McGill University, Montreal QC; Department of Obstetrics and Gynecology, St. Mary's Hospital Center, Montreal QC; Obstetrics Coordinator of the Family Medicine Unit, St. Mary's Hospital Center, Montreal QC.
Sewitch
Maida J
MJ
Department of Family Medicine, McGill University, Montreal QC; Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital Center, Montreal QC.
Cardinal
Linda
L
Quality Assessment Analyst, St. Mary's Hospital Center, Montreal QC.
Brassard
Normand
N
Department of Obstetrics and Gynecology Laval University, Quebec QC; Obstetrician-gynecologist in Chief, Centre Hospitalier, Universitaire de Québec, Québec (Québec).
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D009774:Obstetrics; D010821:Physicians, Family; D011247:Pregnancy; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*