Henry M. Jackson Foundation at the Graduate School of Nursing, Uniformed Services University, Bethesda, Maryland.
School of Nursing, University of Maryland, Baltimore, Maryland.
Birth. 2020 Jun;47(2):227-236. doi: 10.1111/birt.12483. Epub 2020 Feb 12.
Variation in hospital cesarean birth rates across the United States is likely because of differences in practitioner practice patterns. Yet, few studies conducted in the last twenty years have examined the relationships between practitioner characteristics and the use of intrapartum interventions and cesarean birth. The objective of this study was to examine associations among practitioner characteristics and the use of amniotomy, epidural, oxytocin augmentation, and cesarean birth in low-risk women with spontaneous onset of labor.
A secondary analysis was performed using data collected by the Consortium on Safe Labor. The sample included nulliparous term singleton vertex (NTSV) births with spontaneous onset of labor (n = 13 196) from 2002 to 2007 across eight hospitals. Generalized linear mixed models were conducted to examine outcomes.
The cesarean birth rate ranged from 7.2% to 18.9% across hospitals and from 0% to 53.3% across physicians. Practice type (P < .05) and specialty type (P < .0001) were associated with physician cesarean birth rates. Compared with obstetrician/gynecologists, midwives were nearly twice as likely to use no intrapartum interventions (relative risk 1.80 [CI 95 1.45-2.24]) and 26% less likely to use amniotomy-epidural-oxytocin (0.74 [0.62-0.89]). Family practice physicians had a 21% lower likelihood of using amniotomy-epidural-oxytocin (0.79 [0.67-0.94]) and a 53% lower likelihood of performing cesarean births (0.47 [0.35-0.63]).
Wide variation in hospital and physician cesarean birth rates was observed in this sample of low-risk, nulliparous women. Practitioner practice type and specialty were significantly associated with the use of intrapartum interventions. Interprofessional practitioner education could be one strategy to reduce variation of intrapartum care and cesarean birth.
美国医院剖宫产率的差异可能是由于从业者实践模式的差异造成的。然而，在过去二十年中，很少有研究检查从业者特征与产程中干预措施和剖宫产之间的关系。本研究的目的是检查低危、自发性临产的初产妇从业者特征与羊膜切开术、硬膜外麻醉、催产素增强和剖宫产之间的关系。
使用安全分娩联盟收集的数据进行二次分析。该样本包括 2002 年至 2007 年 8 家医院自发性临产的初产妇足月单胎头位（NTSV）分娩（n=13196）。使用广义线性混合模型检查结果。
医院剖宫产率从 7.2%到 18.9%不等，医生剖宫产率从 0%到 53.3%不等。执业类型（P<0.05）和专业类型（P<0.0001）与医生剖宫产率相关。与妇产科医生相比，助产士使用产程中无干预措施的可能性几乎高出一倍（相对风险 1.80[95%置信区间 1.45-2.24]），使用羊膜切开术-硬膜外麻醉-催产素的可能性低 26%（0.74[0.62-0.89]）。家庭执业医生使用羊膜切开术-硬膜外麻醉-催产素的可能性低 21%（0.79[0.67-0.94]），剖宫产的可能性低 53%（0.47[0.35-0.63]）。
在本低危、初产妇样本中，观察到医院和医生剖宫产率存在广泛差异。从业者的实践类型和专业与产程中干预措施的使用显著相关。跨专业从业者教育可能是减少产程护理和剖宫产差异的一种策略。
