Effects of obstetrician characteristics on cesarean delivery rates. A community hospital experience

Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1364-72. doi: 10.1016/s0002-9378(99)70021-9.


Objective: Despite a decrease in the overall cesarean delivery rate at Ravenswood Hospital Medical Center in Chicago, a wide range of variation existed among individual obstetricians' rates. This study evaluated obstetricians' characteristics to determine whether they affected cesarean delivery rates.

Study design: In 1994 members of my department adopted strategies to decrease the cesarean delivery rate. Data on women who were delivered at the obstetric unit from 1994-1997 and data on their neonates were studied. Certain characteristics of obstetricians were also analyzed. The data were grouped according to personal characteristics and obstetricians' cesarean delivery rates: group 1 had a low rate (</=15%) and group 2 had a high rate (>15%). Pearson chi2 analysis was used to evaluate the differences between the proportions. P <.05 was considered significant.

Results: The departmental cesarean delivery rate decreased from 20.5% in 1994 to 15.5% in 1997 (P <.0001), whereas individual obstetricians' rates varied from 0% to 44.4%. Obstetricians in group 1 (average rate 12.2%) and group 2 (average rate 20.8%, P <.0001) served similar populations with similar outcomes. Compared with obstetricians in group 2, those in group 1 (low rate) performed more vaginal deliveries after cesarean birth and used epidural analgesia and the vacuum extractor more frequently. Young age of physician, graduation from a domestic medical school, group practice, and smaller volume of births were all significantly linked to lower cesarean delivery rates.

Conclusions: Cesarean delivery rates can safely be reduced. Certain individual obstetrician characteristics influence cesarean delivery rates. Obstetricians' commitment facilitates lowering of cesarean delivery rates.

MeSH terms

  • Adult
  • Birth Weight
  • Cesarean Section / statistics & numerical data*
  • Female
  • Hospitals, Community*
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Insurance, Health
  • Labor, Induced
  • Male
  • Maternal Age
  • Obstetrical Forceps
  • Obstetrics* / education
  • Parity
  • Practice Patterns, Physicians'*
  • Pregnancy