THE IMPACT OF MANDATED IN-HOSPITAL COVERAGE ON PRIMARY CESAREAN DELIVERY RATES IN A LARGE NONUNIVERSITY TEACHING HOSPITAL

OBJECTIVE: Our purpose was to determine whether attending physician ca ll status affected the primary cesarean delivery rates of the resident or private services after institution of in-hospital coverage. STUDY DESIGN: Data for the study year, during which in-hospital attending co verage was in place, were compared with those of the previous year, du ring which in-hospital attending coverage of residents was not in plac e. Birth records were analyzed retrospectively for physician and patie nt factors. RESULTS: For the year before in-hospital coverage the inst itutional total cesarean rate was 24.9%, with a primary cesarean secti on rate of 17.6%. In the first year of coverage the total cesarean del ivery was 21.7%, with a decrease in the primary rate to 15.3%. The res ident service primary cesarean delivery rate was 10.6% during the stud y year, which was unchanged from 10.9% the prior year and did not cont ribute to the overall decrease. Conversely, the private service primar y cesarean rate decreased from 18.0% in the prestudy year to 13.4% whe n the attending physician was on call in the hospital but remained hig her at 17.5% when the attending physician was on call not in the hospi tal. CONCLUSIONS: In-hospital attending physician coverage lowered ind ividual attending physicians' private service primary cesarean rates. Resident service primary cesarean rates were lower than private servic e and were unaffected by the initiation of in-hospital coverage.