Relation of private or clinic care to the cesarean birth rate.

The rising rate of cesarean births in the United States has been the focus of academic attention as well as attention from the media during the past decade. Although there is a consensus about the indications for cesarean delivery that have led to the increased rate (dystocia, malpresentation, fetal distress, and previous cesarean delivery), the influence of other key factors, such as whether the patient received care from a private physician or through a hospital clinic, has not been established. In a review of 65,647 deliveries in four Brooklyn hospitals between 1977 and 1982, we found that private physicians performed significantly more cesarean sections than house officers and attending physicians. Private patients giving birth to their first child were significantly more likely than clinic patients to undergo cesarean delivery if dystocia, malpresentation, or fetal distress was diagnosed, and private patients with one or more previous deliveries were significantly more likely to undergo cesarean delivery if dystocia or malpresentation was diagnosed. Private patients had fewer perinatal deaths, which were concentrated among infants with birth weights under 2000 g, but the infants of private patients had a significantly higher rate of low Apgar scores and birth injuries than the infants of clinic patients.