Provider distribution and variations in statewide cesarean section rates

Area of Science:

• Obstetrics and Gynecology
• Health Services Research

Background:

• Cesarean section rates exhibit significant state-level variation, suggesting non-clinical factors influence delivery decisions.
• Patient factors alone do not account for the wide disparities in cesarean rates across states.

Purpose of the Study:

• To investigate the association between provider workforce characteristics and statewide cesarean delivery rates.
• To determine if factors like obstetrician delivery volume, nurse midwife utilization, or family physician involvement correlate with cesarean rates.

Main Methods:

• A linear regression model was employed using 1996 statewide cesarean delivery rates as the dependent variable.
• Independent variables included: deliveries per board-certified obstetrician, percentage of deliveries by nurse midwives, and percentage of family physicians performing obstetrics.
• The model adjusted for state rurality and median income.

Main Results:

• Only the percentage of family physicians providing obstetric services was significantly associated with statewide cesarean delivery rates.
• A higher percentage of family physicians performing obstetrics correlated with lower cesarean delivery rates.
• This association remained significant after adjusting for rurality, income, and other provider factors.

Conclusions:

• Family physician participation in obstetrics appears to be a marker for practice environments that favor non-operative obstetric care.
• The findings suggest that the medical environment and practice style, rather than solely provider numbers, influence cesarean delivery rates.