Evaluation of Cesarean Delivery Risk by Physician Sex

Yuki Joyama; Misa Hayasaka; Lindsay Speros Robbins; George Saade; Tetsuya Kawakita

doi:10.1055/a-2615-5055

American Journal of Perinatology, Table of Contents

Am J Perinatol
DOI: 10.1055/a-2615-5055

Original Article

Evaluation of Cesarean Delivery Risk by Physician Sex

Yuki Joyama

¹Biostatistics, Columbia University Mailman School of Public Health, New York, United States (Ringgold ID: RIN33638)

,

Misa Hayasaka

²Obstetrics and Gynecology, Macon & Joan Brock Virginia Health Sciences at Old Dominion University Eastern Virginia Medical School, Norfolk, United States (Ringgold ID: RIN695748)

,

Lindsay Speros Robbins

²Obstetrics and Gynecology, Macon & Joan Brock Virginia Health Sciences at Old Dominion University Eastern Virginia Medical School, Norfolk, United States (Ringgold ID: RIN695748)

,

George Saade

³OB-GYN, EVMS, Norfolk, United States (Ringgold ID: RIN6040)

,

Tetsuya Kawakita

⁴Maternal Fetal Medicine, Eastern Virginia Medical School, Norfolk, United States (Ringgold ID: RIN6040)

› Author Affiliations

Abstract

PDF Download

Objective: To examine the association between physician sex, cesarean delivery, and neonatal complications. Study Design: We analyzed the Consortium on Safe Labor (CSL) database including 228,437 deliveries from 2002 to 2008. The study focused on singleton pregnancies with cephalic presentations, excluding cases with contraindications to vaginal delivery, elective cesarean deliveries, and non-OBGYN (obstetricians and gynecologists) or MFM (maternal-fetal medicine) physician management. The primary outcome of this study was cesarean delivery; secondary outcomes were cesarean delivery due to arrest of dilation or descent, cesarean delivery for non-reassuring fetal heart tracings (NRFHT), cesarean delivery for other indications, and a composite of neonatal complications. To estimate adjusted marginal effects (AMEs) in percentage points (pp) with 95% confidence intervals (95% CI) of cesarean delivery between male and female physicians, we performed generalized estimating equations with Poisson distribution and exchange-correlation structure, adjusting for maternal, physician-level characteristics, and hospital-fixed effects. Results: Of 108,004 individuals, 46,779 (43.3%) were attended by 183 female physicians, and 61,225 (56.7%) were attended by 250 male physicians. Female physicians were associated with a lower overall adjusted cesarean delivery proportion (11.93% vs. 13.47%; AME -1.54 pp [95% CI -2.35, -0.73]), cesarean delivery for failure to progress (5.72% vs. 6.48%; AME -0.76 pp [95% CI -1.24, -0.27]), and cesarean delivery for indications except for failure to progress or non-reassuring fetal heart tracings (NRFHT) (1.68% vs. 2.01%; AME -0.33 pp [95% CI -0.56, -0.10]). There were no significant differences in cesarean outcomes for NRFHT or composite neonatal complications between male and female physicians. Conclusion: Compared to male physicians, female physicians had a lower rate of cesarean delivery. Further research is needed to understand the underlying mechanisms and develop targeted interventions.

PDF (1896 kb)