THE OBSTETRICIAN GROUP, NOT EPIDURAL ANALGESIA, INFLUENCES THE CESAREAN SECTION RATE FOR THE NULLIPAROUS WOMAN IN LABOR

Abstract

S249 INTRODUCTION: There are a number of factors, e.g., parity, maternal age, and weight of the baby that are associated with an increase in the cesarean section rate for the woman in labor. The effect of two such factors, the use of regional anesthesia [1] and the individual obstetrician [2] on the cesarean section rate have been analyzed separately but never in one study, and their impact remains equivocal. The purpose of this study was to determine if epidural analgesia or the patient's obstetrician group is associated with an increase in the cesarean section rate. METHODS: During a one year period, data were collected from the medical records of all women on post partum day one who delivered their first baby, had a private obstetrician who delivers > 20 babies per year, and who presented with a singleton gestation in the vertex position for a trial of labor. The data collected included patient age, birth weight, the use of epidural analgesia, the obstetrician group that delivered the baby, and the method of delivery. Women who had a cesarean section for fetal distress were excluded. An association between each variable and cesarean delivery was sought with the chi square test and then entered into a logistic regression analysis to determine if the variables are independent risk factors for cesarean delivery. P < 0.05 was considered significant. RESULTS: Data were collected on 759 patients representing 13 groups of obstetricians. The obstetrician groups ranged in size from 1 to 4 individual practitioners. Overall, the epidural rate was 92% and the cesarean section rate was 15%. The epidural rate among groups ranged from 81% to 100% and the cesarean section rate ranged from 7% to 32%. Both the chi square and the logistic regression analyses revealed that birth weight, patient age, and the obstetrician group were associated with an increase in cesarean section rate, but not the use of epidural anesthesia. (Table 1)Table 1: Logistic Regression AnalysisDISCUSSION: The individual obstetrician group but not the use of epidural analgesia is associated with an increase in the cesarean section rate. It is possible that in studies in which epidural analgesia was implicated as a risk factor for cesarean section, the individual obstetrician or group was a confounding variable. We suggest that in future studies regarding epidural analgesia and cesarean section rate, the obstetrician be included as a potential variable.