The Green Bay cesarean section study. I. The physician factor as a determinant of cesarean birth rates

This study was designed to identify the determinants of cesarean birth rates. The study population included all 1030 cesarean deliveries performed on singleton pregnancies by 11 obstetricians practicing at two Green Bay hospitals from 1986 through 1988; 1076 control patients with vaginal deliveries were selected for comparison purposes. The 1030 cesarean deliveries represented 14% of the 7335 singleton deliveries that occurred during the study period. Individual physician cesarean rates ranged from 5.6% to 19.7%. Cesarean rates for physician groups ranged from 9.8% to 18%. The variances in cesarean rates among individual and groups of physicians were not attributable to patient obstetric risk factors, socioeconomic status, service status, or duration of the physician's practice. Higher cesarean rates did not result in better neonatal outcome. Individual physician practice style was the only apparent determinant of cesarean rates for the 11 obstetricians. Current cesarean rates can be substantially reduced without sacrificing fetal and newborn safety.