ARE RURAL FAMILY PHYSICIANS COMFORTABLE PERFORMING CESAREAN-SECTIONS

BACKGROUND. Provision of obstetric care in the United States requires the capacity to perform cesarean sections. It is unknown who actually performs these procedures in rural hospitals and whether nonobstetrici ans feel comfortable performing cesarean sections. METHODS. We conduct ed a telephone survey of the 41 rural hospitals in Washington State, a sking about the obstetric services offered and the composition and obs tetrical practices of physician staff. A supplementary questionnaire w as sent to the 112 family physicians providing obstetric services in t he subset of hospitals with 50 or fewer beds, asking whether they perf ormed cesarean sections. Eighty-six responded, for a response rate of 75%. RESULTS. Thirty-one (75%) of the rural hospitals provide obstetri c services; of the 31 hospitals, 19 (61%) had no obstetricians on staf f. In these hospitals the majority of physicians on staff both practic e obstetrics and perform cesarean sections. Family physicians performe d the majority of cesarean sections in all but the eight largest rural hospitals; even in these large hospitals (mean annual deliveries, 785 ), family physicians performed 28% of the cesarean sections. Most fami ly physicians who performed cesarean sections felt very comfortable pe rforming these operations. There was a strong association between the number of cesarean sections performed in formal residency training set tings and the family physician's comfort level. CONCLUSIONS. Cesarean sections remain an important service in those rural hospitals providin g obstetric services. Most Washington State rural hospitals depend on family physicians for this operative intervention, Physicians' comfort in doing cesarean sections appears to be closely related to prior for mal training during residency. This relationship suggests that trainin g programs preparing future rural physicians need to ensure adequate t raining in this area for their residents.