Obstetric referral in family practice. Factors Affecting Cesarean Section (FACS) Study Group

This study examines referral patterns of family physicians who perform obstetrics to determine the effects of referral bias on family physician and obstetrician patient populations.

A retrospective review of deliveries from five medical centers over a 2-year period produced a sample of 2568 women who began their obstetric care with family physicians and 2648 whose labor was initially managed by family physicians. To determine which demographic and risk factors are associated with an increased likelihood of referral, those who were referred to obstetricians before the onset of labor (early referrals) and those who were referred during labor (late referrals) were identified and compared with patients who were not referred.

Of the initial 2701 patients who entered care with family physicians, 167 were early referrals and 249 were late referrals. Early referrals were more likely to have had a prior cesarean section (32% vs 3% of those not referred, P < .001) or malpresentation (10% vs 4%, P < .001) than those who were not referred. Among patients referred during labor, previous cesarean section (10% vs 2%, P < .001) and preeclampsia (12% vs 6%, P < .001) were more common.

These data suggest that referral bias is not a major source of differences in patient populations cared for by family physicians and obstetricians.