Deliveries by family physicians in Connecticut: results of a practice-based research network.

Abstract

To obtain descriptive data on deliveries performed by family physicians in Connecticut during 1 year. All family physicians in Connecticut who provided obstetric care were personally contacted to enlist their participation in a research network. All such physicians agreed to participate and were instructed to mail a 15-item delivery data card to the author following each delivery that they participated in during calendar year 1996. Method of delivery, use of obstetric intervention (eg, oxytocin administration, episiotomy, and epidural anesthesia), and obstetric consultation rates. Thirty-two physicians, representing 9.0% of the family practice workforce in Connecticut, provided obstetric care. These 32 physicians, who practice in only 7 of the 31 acute care hospitals in the state, delivered 478 neonates during 1996. Most deliveries were by the spontaneous vaginal route, with forceps and vacuum used in 2.1% and 5.0% of vaginal deliveries, respectively. The primary cesarean section rate of these family physicians was low at 5.6% compared with a statewide rate for all providers (physicians and certified nurse midwives) of 12.4% (odds ratio, 0.42; 95% confidence interval, 0.28-0.63). Rates of certain obstetric interventions, such as oxytocin administration, epidural anesthesia, and episiotomy, varied greatly by hospital. Obstetric consultation rates also varied greatly among hospitals, ranging from 12.8% to 49.6%. Family physician involvement in maternity care in Connecticut is low. This study confirms a low rate of instrument-assisted and cesarean delivery in births attended by family physicians. Use of obstetric interventions and obstetric consultation varies greatly within the state.