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The Association between Solo versus Group Obstetrical Practice Model and Delivery Outcomes
Jonah Bardos1, Holly Loudon1, Patricia Rekawek1
1Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.
American Journal of Perinatology
|November 6, 2018
Summary
Obstetrician practice type (solo vs. group) impacts delivery management, with solo practices showing higher cesarean rates but fewer severe complications. Neonatal outcomes are comparable, suggesting solo practices are a viable model.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Health Services Research
Background:
- Understanding variations in obstetric care delivery models is crucial for optimizing patient outcomes.
- Solo and group practice models may influence clinical decision-making during labor and delivery.
Purpose of the Study:
- To compare delivery outcomes between women cared for by obstetricians in solo practice versus group practice.
- To evaluate the impact of practice model on cesarean delivery rates, severe perineal lacerations, shoulder dystocia, and neonatal intensive care unit admissions.
Main Methods:
- Retrospective cohort study of live, term, singleton, vertex (LTSV) deliveries.
- Data collected from a single tertiary care hospital between 2011 and 2015.
- Comparison of outcomes based on whether the attending obstetrician was in solo or group practice.
Main Results:
- Solo obstetricians were more likely to perform deliveries at night and less likely to induce labor.
- Cesarean delivery rates were significantly higher in solo practices (35.7% vs. 27.2%).
- Solo practices demonstrated significantly lower rates of shoulder dystocia, severe perineal lacerations, and neonatal intensive care unit admissions.
Conclusions:
- Solo obstetricians exhibit a more conservative approach to labor management, reflected in higher cesarean rates but fewer adverse maternal and neonatal outcomes.
- Neonatal outcomes were similar between solo and group practices.
- Patient outcomes do not support discouraging the solo obstetric practice model.
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