Canadian Medical Association Journal, Vol 140, Issue 6 625-633, Copyright © 1989 by Canadian Medical Association

JOURNAL ARTICLE

Differences in intrapartum obstetric care provided to women at low risk by family physicians and obstetricians

A. J. Reid, J. C. Carroll, J. Ruderman and M. A. Murray
Department of Family and Community Medicine, University of Toronto.

To determine differences in practice style and to examine maternal and neonatal outcomes, we reviewed the hospital charts of 1115 women admitted by family physicians and 1250 women admitted by obstetricians who gave birth at one of three teaching hospitals in Toronto between April 1985 and March 1986. All the women in the two groups were categorized retrospectively as being at low risk at the onset of labour on the basis of their prenatal records and their admission histories and physical examination results. There were higher proportions of younger women and women of lower socioeconomic status in the family physician group than in the obstetrician group (p less than 0.001). The rates of interventions, including artificial rupture of the membranes, induction, augmentation, low forceps plus vacuum extraction, episiotomy and epidural anesthesia, were all higher in the obstetrician group. The mean birth weight and the cesarean section rate were the same in the two groups. Differences in labour and delivery outcomes between the two groups, including a higher rate of spontaneous vaginal delivery for the family physicians, reflected a more "expectant" practice style by family doctors. However, there were no significant differences in the rates of maternal or neonatal complications. A practice style characterized by a higher rate of interventions was not associated with improved maternal or newborn outcome in this low-risk setting.

This article has been cited by other articles:

				R. E. Allen and R. W. Hanson Jr Episiotomy in Low-Risk Vaginal Deliveries J Am Board Fam Med, January 1, 2005; 18(1): 8 - 12. [Abstract] [Full Text] [PDF]

				D A Webb and J Culhane Time of day variation in rates of obstetric intervention to assist in vaginal delivery J Epidemiol Community Health, August 1, 2002; 56(8): 577 - 578. [Full Text] [PDF]

				M. C. Klein, A. Spence, J. Kaczorowski, A. Kelly, and S. Grzybowski Does delivery volume of family physicians predict maternal and newborn outcome? Can. Med. Assoc. J., May 1, 2002; 166(10): 1257 - 1263. [Abstract] [Full Text] [PDF]

				M. Godwin, G. Hodgetts, R. Seguin, and S. MacDonald The Ontario Family Medicine Residents Cohort Study: factors affecting residents' decisions to practise obstetrics Can. Med. Assoc. J., January 1, 2002; 166(2): 179 - 184. [Abstract] [Full Text]

				W. J. Hueston Site-to-Site Variation in the Factors Affecting Cesarean Section Rates Arch Fam Med, April 1, 1995; 4(4): 346 - 351. [Abstract] [PDF]

				V A Hundley, F M Cruickshank, G D Lang, C M A Glazener, J M Milne, M Turner, D Blyth, J Mollison, and C Donaldson Midwife managed delivery unit: a randomised controlled comparison with consultant led care BMJ, November 26, 1994; 309(6966): 1400 - 1404. [Abstract] [Full Text]

				K. M. Parrish, V. L. Holt, T. R. Easterling, F. A. Connell, and J. P. LoGerfo Effect of Changes in Maternal Age, Parity, and Birth Weight Distribution on Primary Cesarean Delivery Rates JAMA, February 9, 1994; 271(6): 443 - 447. [Abstract] [PDF]

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-1989, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.