title: Does the presence of learners affect family medicine obstetric outcomes?
abstract: OBJECTIVE
  To compare patient outcomes and complications before and after involvement of family medicine residents in intrapartum care.
  
  
  METHODS
  Secondary data analysis.
  
  
  METHODS
  London, Ont.
  
  
  METHODS
  Obstetric patients of a family physician with a special interest in obstetrics.
  
  
  METHODS
  Total number of births attended and births missed, as well as rates of inductions, augmentations for dystocia, augmentations for prelabour ruptured membranes, types of births (ie, normal vaginal, vacuum-assisted, low and outlet forceps deliveries; cesarean sections; and obstetrician-assisted vaginal births), and perineal outcomes (ie, intact; first-, second-, third-, or fourth-degree tears; episiotomies; and episiotomies with third-or fourth-degree extensions).
  
  
  RESULTS
  During the period of time when family medicine residents were involved in intrapartum care, women sustained slightly more second-degree tears, and more cesarean sections were performed. Fewer women had vacuum-assisted births or unmedicated births. There were no significant differences in rates of normal vaginal births, low and outlet forceps deliveries, and perineal trauma (other than second-degree tears) including episiotomies.
  
  
  CONCLUSIONS
  Women experienced slightly more second-degree tears when residents were involved in their deliveries. The increased number of second-degree tears might be because of residents' limited experience in providing intrapartum care. More important, there was no increase in other serious perineal trauma or episiotomy when residents provided supervised intrapartum care. This should reassure women and family practice obstetricians who choose to receive and provide obstetric care in a family practice teaching unit. The increase in rates of epidural use and cesarean sections and the decrease in rates of vacuum-assisted births reflect obstetric trends in Canada over the past decade.
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Hammond
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000193:education / Q000379:methods / Q000706:statistics & numerical data*; D005194:Family Practice / Q000193:education / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000706:statistics & numerical data*; D008131:London / Q000453:epidemiology; D008137:Longitudinal Studies; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D009774:Obstetrics / Q000193:education / Q000706:statistics & numerical data*; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D012189:Retrospective Studies