Article Figures & Tables
Figures
- Figure 1
Flow diagram showing cohort selection. *Hospitals with fewer than 20 cesarean deliveries performed in women living within their catchment area.
Tables
- Table 1 Selected characteristics of women who gave birth between Apr. 1, 2006, and Mar. 31, 2009, at all Canadian hospitals except those in Quebec, by delivery provider
Characteristic Provider; no. (%) of women* Family physician
n = 217 870Obstetrician
n = 558 429Cesarean delivery 24 830 (11.4) 192 360 (34.4) Age, mean ± SD, yr 28.2 ± 5.6 29.6 ± 5.7 Income, mean ± SD, $ 26 821 ± 8827 27 777 ± 9250 % of women in census subdivision with at least some high school, mean ± SD 81.7 ± 14.1 84.0 ± 12.5 Urban residence† 151 459 (69.5) 474 695 (85.0) Hospital level 3 53 901 (24.7) 150 098 (26.9) 2 77 640 (35.6) 298 269 (53.4) 1 85 642 (39.3) 110 051 (19.7) Prior cesarean delivery 11 229 (5.2) 89 265 (16.0) Type 1 diabetes 89 (0.04) 1945 (0.3) Type 2 diabetes 167 (0.1) 2201 (0.4) Gestational diabetes 7280 (3.3) 29 059 (5.2) Eclampsia 96 (0.04) 374 (0.1) Placental abruption 176 (0.1) 1111 (0.2) Premature rupture of membranes 697 (0.3) 3660 (0.6) Placenta previa 362 (0.2) 3065 (0.5) Genital herpes 236 (0.1) 848 (0.2) Gestational age, mean ± SD, wk 39.3 ± 2.0 38.8 ± 2.3 Birth weight, mean ± SD, g 3463 ± 501 3375 ± 582 Congenital anomaly 4658 (2.1) 18 779 (3.4) *Except where noted otherwise.
†Census agglomeration or census metropolitan area.
- Table 2: Selected characteristics of the study cohort by quintile of family physician delivery rate at the home hospital, included as variables in logistic regression and instrumental variable analyses
Characteristic Quintile of family physician delivery rate; no. (%)* 1
n = 148 0592
n = 158 5933
n = 160 5184
n = 151 2065
n = 157 923All
n = 776 299Missing data† 1766 (1.2) 2207 (1.4) 2400 (1.5) 4726 (3.1) 2980 (1.9) 14 079 (1.8) Predicted cesarean delivery rate, mean ± SD‡ 28.4 ± 22.7 28.9 ± 22.7 27.8 ± 22.4 27.8 ± 22.6 27.1 ± 22.7 28.0 ± 22.7 Income, mean ± SD, $ 27 222 ± 8581 28 601 ± 10 314 28 408 ± 9175 26 604 ± 8438 26 632 ± 8822 27 509 ± 9144 % Aboriginal, mean ± SD 3.6 ± 13.9 2.4 ± 8.8 5.8 ± 15.2 5.9 ± 14.4 10.9 ± 22.7 5.8 ± 15.9 Delivery hospital Level 3 13 896 (9.4) 39 481 (24.9) 60 043 (37.4) 53 996 (35.7) 36 583 (23.2) 203 999 (26.3) Annual volume, mean ± SD 2626 ± 1548 3579 ± 1665 2936 ± 1567 3462 ± 2260 2016 ± 1988 2923 ± 1913 Delivery provider Annual volume, mean ± SD 269 ± 131 260 ± 151 252 ± 210 176 ± 150 96 ± 103 210 ± 167 Obstetrician 141 732 (95.7) 144 028 (90.8) 133 475 (83.2) 90 462 (59.8) 48 732 (30.8) 558 429 (71.9) Family physician 6327 (4.3) 14 565 (9.2) 27 043 (16.8) 60 744 (40.2 109 191 (69.1) 217 870 (28.1) Midwife† 5938 (4.0) 7621 (4.8) 7273 (4.5) 5657 (3.7) 4743 (3.0) 31 232 (4.0) Maternal Age, mean ± SD, yr 29.3 ± 5.7 30.5 ± 5.5 29.0 ± 5.6 29.3 ± 5.7 28.2 ± 5.7 29.2 ± 5.7 % of women in census subdivision with at least some high school, mean ± SD 83.0 ± 12.7 86.5 ± 11.2 83.4 ± 12.8 83.5 ± 12.4 80.2 ± 15.1 83.3 ± 13.0 Urban residence 128 533 (86.8) 147 590 (93.1) 136 309 (84.9) 118 755 (78.5) 94 967 (60.1) 626 154 (80.6) Cesarean delivery 42 010 (28.4) 45 214 (28.5) 43 585 (27.2) 42 212 (27.9) 44 169 (28.0) 217 190 (28.0) Prior cesarean delivery 19 454 (13.1) 21 011 (13.2) 20 084 (12.5) 19 472 (12.9) 20 473 (13.0) 100 494 (12.9) Type 1 diabetes 429 (0.3) 390 (0.2) 471 (0.3) 373 (0.2) 371 (0.2) 2034 (0.3) Type 2 diabetes 409 (0.3) 449 (0.3) 615 (0.4) 404 (0.3) 491 (0.3) 2368 (0.3) Gestational diabetes 6595 (4.4) 8107 (5.1) 6515 (4.0) 8775 (5.8) 6347 (4.0) 36 339 (4.7) Eclampsia 120 (0.05) 89 (0.1) 102 (0.1) 62 (0.04) 97 (0.1) 470 (0.1) Pregnancy-induced hypertension 8430 (5.7) 8481 (5.3) 10 381 (6.5) 9292 (6.1) 10 046 (6.4) 46 630 (6.0) HIV-positive 76 (0.05) 81 (0.05) 100 (0.1) 118 (0.1) 63 (0.04) 438 (0.05) Placental abruption 185 (0.1) 166 (0.1) 469 (0.3) 250 (0.2) 217 (0.1) 1287 (0.2) Premature rupture of membranes 414 (0.3) 387 (0.2) 2143 (1.3) 939 (0.6) 474 (0.3) 4357 (0.6) Neonatal Male sex 75 785 (51.2) 81 326 (51.3) 82 248 (51.2) 77 872 (51.5) 80 902 (51.2) 398 133 (51.3) Gestational age, mean ± SD, wk 38.9 ± 2.2 38.9 ± 2.0 38.9 ± 2.4 38.9 ± 2.1 39.1 ± 2.5 38.9 ± 2.2 Birth weight, mean ± SD, g 3382 ± 566 3360 ± 557 3417 ± 567 3393 ± 556 3443 ± 557 3399 ± 562 Congenital anomaly 4423 (3.0) 4502 (2.8) 5227 (3.2) 4906 (3.2) 4379 (2.8) 23 437 (3.0) Perinatal mortality 686 (0.5) 700 (0.4) 597 (0.4) 628 (0.4) 600 (0.4) 3211 (0.4) *Except where noted otherwise.
†Records with missing data and deliveries by midwives were excluded from the final analysis.
‡Calculated from a logistic regression model including all covariates except for delivery provider.
- Table 3: Relative risk of cesarean delivery, forceps- or vacuum-assisted vaginal delivery and all procedural deliveries for family physicians versus obstetricians on logistic and instrumental-variable-adjusted regression
Method RR (95% CI) Cesarean delivery Forceps- or vacuum-assisted vaginal delivery All procedural deliveries Logistic regression Bivariate 0.33 (0.27-0.40) 1.02 (0.91-1.13) 0.35 (0.31-0.40) Multivariate* 0.48 (0.41-0.56) 1.00 (0.92-1.09) 0.61 (0.56-0.67) Instrumental-variable-adjusted regression Bivariate 0.96 (0.79-1.17) 0.92 (0.74-1.12) 0.94 (0.82-1.09) Multivariate* 1.27 (1.02-1.57) 1.03 (0.82-1.29) 1.16 (0.99-1.35) Note: CI = confidence interval, RR = relative risk.
*Multivariate adjusted models controlled for all comorbidities listed in Appendix 1.
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