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

Evaluation of Cesarean Delivery Risk by Physician Sex

Authors

  • Yuki Joyama

    1   Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York

  • Misa Hayasaka

    2   Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia

  • Lindsay Robbins

    2   Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia

  • George Saade

    2   Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia

  • Tetsuya Kawakita    *

    2   Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia

Funding This study was supported by the Eastern Virginia Medical School (grant number: VHS 241231).
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Abstract

Objective

This study aimed to examine the association between physician sex, cesarean delivery, and neonatal complications.

Study Design

We analyzed the Consortium on Safe Labor 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 nonobstetricians and gynecologists or 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 nonreassuring fetal heart tracings (NRFHT), cesarean delivery for other indications, and a composite of neonatal complications. To estimate average 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 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 with male physicians, female physicians had a lower rate of cesarean delivery. Further research is needed to understand the underlying mechanisms and develop targeted interventions.

Key Points

  • Compared with male physicians, female physicians had a lower rate of cesarean delivery.

  • This reduction was particularly evident for cesarean deliveries due to failure to progress.

  • The reduction was not associated with an increased risk of neonatal complications.

Keywords

maternal–fetal medicine - multiparas - nulliparas - obstetrics and gynecology - surgeon sex

* Principle Investigator.


Supplementary Material



Publication History

Received: 07 April 2025

Accepted: 18 May 2025

Accepted Manuscript online:
19 May 2025

Article published online:
03 June 2025

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