Differences Among Obstetricians in Caesarean Section Rates

• Published in: Australian & New Zealand journal of obstetrics & gynaecology 1997-11, Vol.37 (4), p.387-392
• Main Author: Menticoglou, Savas M.
• Format: Article
• Language: English
• Subjects: Cesarean Section - statistics & numerical data; Decision Making; Hospitals, Maternity; Humans; Manitoba - epidemiology; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies
• ISSN: 0004-8666; 1479-828X
• DOI: 10.1111/j.1479-828X.1997.tb02444.x

EDITORIAL COMMENT: The editor was once engaged in what was said to be the longest ever running case of medical investigation in Australia against an obstetrician whose Caesarean section rate was claimed to be excessive. The leading expert witnesses on both sides of the case were required to table the Caesarean section rates in their private practices. Who will be surprised to learn that both, including the editor, reported a rate above 20%. We are all charitable to ourselves when relating the high‐risk nature of our private practices, with many women referred with previous Caesarean section or poor perinatal result. This paper is carefully restricted to low‐risk nulliparas. In Melbourne, for a time, it was practice to notify each consultant of his/her Caesarean section rate and each was provided with an anonymous list of his/her colleagues' rates. In the Mc Bride case referred to above, the Judge asked the expert witness ‐ ‘do not the doctors in your institution with notification of low Caesarean rates fear accusation of malpractice?’ Summary: This retrospective study examined the Caesarean section rates of 15 obstetricians at 1 hospital delivering 5,559 nulliparas with a single cephalic baby of birth‐weight ≥ 2,500 g. There was a wide variation in obstetricians' Caesarean rates, whether considering all their deliveries (5.5% to 20.1%), deliveries of their own patients (8.9% to 28.2%), or deliveries of their colleagues' patients (4.5% to 17.9%). There was no relation between Caesarean rates and perinatal outcome. The different Caesarean section rates among the obstetricians could not be explained by institutional factors, physician convenience, patient differences, or self‐serving economic incentives.