Low-volume obstetrics. Characteristics of family physicians' practices in Alberta.

OBJECTIVE

To compare the obstetric practices of family physicians who attended fewer than 25 births per year (low-volume) with the practices of family physicians who attended more than 25 births per year (high-volume) and the practices of obstetricians.

DESIGN

Retrospective cohort study using data from administrative databases.

SETTING

Alberta.

PARTICIPANTS

All physicians who provided intrapartum care between April 1, 1997, and March 31, 2000.

MAIN OUTCOME MEASURES

Type of delivery, size of hospitals where deliveries took place, characteristics of patients, and number of medical interventions.

RESULTS

Of 1026 family physicians, 543 (53%) were low-volume providers of intrapartum care. In 1997-1998, low-volume family physicians (LVFPs) attended 24% of all vaginal and cesarean births attended by family physicians; by 1998-1999, that percentage had decreased to 9%; and by 1999-2000, to 5%. In contrast, the number of births attended by all family physicians remained relatively constant at 43% during the 3 years. In hospitals that had fewer than 50 deliveries a year, LVFPs attended almost half the births. Although LVFPs did fewer medical inductions, vacuum extractions, and epidural anesthetics and more forceps extractions, episiotomies, and cesarean sections than high-volume family physicians (HVFPs), the differences between their practices were much smaller than the differences between all family physicians' practices and the practices of obstetricians (who treat higher-risk mothers and newborns).

CONCLUSION

The decrease in LVFPs' obstetric practices could make a pronounced difference at smaller hospitals where most low-volume practice occurs.