Association of attending physician specialty with the cesarean delivery rate in the same patient population

Background and Objectives: In the context of a dramatic increase in US cesa rean delivery rates over the past 30 years and explicit national goals to d ecrease the cesarean rate, previous retrospective studies have shown that p regnant women cared for by family physicians may be less likely to undergo cesarean delivery: compared with? patients cared for by obstetricians. Meth ods: We conducted a retrospective chart review of 3,560 deliver ies front t he family practice service of a community-based family practice residency f rom 1986-1995, focusing primarily on cesarean delivery rates during two per iods of time. During period I (n = 1,063), all attendings were private prac tice obstetricians. After a transition period, all births were attended by family medicine faculty (period 2, n = 1,346). Results: The total cesarean delivery rate declined from 16.7% in period I to 11.1% in period 2. Repent cesareans declined from 8.5% to 2.9%. Conclusions: In this community-based residency: a change in the specialty of the attending physician was associa ted with a 34% decline ir? the cesarean delivery rate The observed decline in the cesarean rate could not he accounted for by any change in patient de mographics of secular trends in cesarean delivery rates.