One theory behind laborists, obstetricians employed by hospitals to provide 24/7 coverage, is that it will reduce cesarean rates by removing time management considerations from the decision. Medscape, however, reports on a study presented at the Society for Maternal-Fetal 2016 Pregnancy Meeting that shoots down that theory.
Investigators compared cesarean rates among 20 laborists who attended 2224 low-risk (one, head-down baby at full term) 1st-time mothers. They found that despite taking place at a single institution, which eliminated variations in institutional culture and environment, cesarean rates ranged from 12% to 36%. The overall hospital cesarean rate in low-risk 1st-time mothers was 19%, yet among laborists, it was 24%. Furthermore, after grouping the laborists into 3 groups according to low, medium, or high cesarean rate, adjustment for factors known to increase the likelihood of cesarean (hypertension, gestational age at delivery, race, maternal age), increased, rather than shrank, the gap between lowest and highest rates from a 2.9-fold to a 3.6-fold difference. No differences were found in clinical characteristics of the women, indications for cesarean delivery, or newborn outcomes among the three groups. The lead investigator, Dr. Torri Metz, professed herself “shocked” at the range, and commented, “Our findings highlight the impact of individual physician decision-making on the overall cesarean rate.”
With large obstetric groups working in shifts the norm, women already have little say over who attends them in labor. The use of laborists gives them even less, and as this study makes clear, the birth attendant’s practices and philosophy have profound impact on what happens to women and their babies.