title: A comparison of cesarean delivery outcomes for rural family physicians and obstetricians.
abstract: OBJECTIVE
  Despite declining access to obstetrical care in many regions, family physicians often have difficulty obtaining Cesarean delivery privileges. We compared outcomes of Cesarean deliveries performed by family physicians (FPs) and obstetricians (OBs). The last such study done was more than 15 years ago.
  
  
  METHODS
  This study was a chart review of 250 consecutive Cesarean deliveries was done at 2 rural New England hospitals. At one hospital, Cesarean deliveries were performed by FPs; at the other they were done by OBs. Demographics, pregnancy risk factors, and maternal and neonatal complication rates at each site were compared.
  
  
  RESULTS
  Demographics, indications for Cesarean delivery, and prenatal risk factors were comparable at both sites except there were more hypertensive patients at the FP site. There were no differences in intraoperative or infectious complications. There were fewer postoperative complications at the FP hospital, which were mostly attributable to fewer blood transfusions and readmissions. There were no differences in neonatal outcomes, although there were more deliveries of fetuses <38 weeks' gestation at the FP site.
  
  
  CONCLUSIONS
  Patients did not face increased risk when Cesarean deliveries were performed by FPs rather than OBs. A larger, more geographically diverse study is needed to confirm these findings. Results could support FPs seeking privileges to perform Cesarean deliveries, thus expanding access to care for pregnant women.
authors.affiliation: the Dartmouth CO-OP Project, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.
authors.forename: Fay F
authors.initials: FF
authors.lastname: Homan
authors.forename: Ardis L
authors.initials: AL
authors.lastname: Olson
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Johnson
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005194:Family Practice; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D009511:New England; D009774:Obstetrics; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D019035:Rural Health Services
keywords: Cesarean Section; Maternal Morbidity; Obstetrics; Rural Health Services