Strength of indication for cesarean delivery: Comparison of private physician versus resident service labor management, ,

Objective: Our purpose was to compare the strength of indication for cesarean delivery for 2 groups of patients who had undergone cesarean delivery—those treated by physicians in private or group practice and those treated by a clinic or resident service. Study Design: From records of 119 cesarean deliveries performed in 1992, data concerning patient history, labor course and management, fetal monitor tracings, and indications for cesarean delivery were extracted, summarized, and presented to 3 reviewers. Each reviewer rated the strength of indication for cesarean delivery on a 10-point visual analog scale and specified how often they would have chosen an alternative management plan. Reviewers were blinded to the research hypothesis and to patient age, type of provider, and insurance status. Results: Using a multivariate linear regression model to adjust for differences in age and indication for cesarean delivery, we found that strength of indication scores were higher among patients treated by a resident service than among those treated by private physicians (P< .0001) and that an alternative action plan was more often suggested for deliveries managed by private physicians (P< .0001). Conclusions: Among women who underwent cesarean delivery, the strength of indication judged by a panel of reviewers not involved with the patient’s care was stronger among resident-treated patients than among cases treated by private physicians. Although there are several possible explanations, the findings may suggest that physicians in private practice use different criteria than do resident physicians for deciding to perform a cesarean. (Am J Obstet Gynecol 1999;181:435-9.)