Effect of physician characteristics on the cesarean birth rate

The rising cesarean birth rate has become of increasing concern to the obstetric profession and the public. There is a general consensus that the major obstetric indications responsible for the rising rate are dystocia, fetal distress, breech presentation, and previous cesarean delivery. However, the role of sociologic or nonmedical factors has not been established. This retrospective study examines the effect of the physician's age, experience, gender, and practice setting (solo versus group practice) on the cesarean birth rate. The analysis is based on 6327 private deliveries performed by 48 attending obstetrician/gynecologists at a New York City Hospital from January 1983 through December 1985. Although no significant differences were found according to the gender or practice setting of the physicians, older, more experienced physicians performed significantly fewer cesarean sections for dystocia and a higher percentage of forceps deliveries and breech extractions. These results suggest that physician characteristics may affect the type of delivery that is performed.