Phillips R N, Thornton J, Gleicher N
JAMA. 1982 Sep 3;248(9):1082-4.
Various aspects of physician bias in the decision to perform a cesarean section were investigated by comparing indications for cesarean sections for 1979 and 1980 and investigating the distribution of indications according to the day of the week. The contention that obstetricians may perform cesarean sections on weekends for secondary gain was refuted by showing no difference in the distribution of nonelective cesarean section indications between weekdays and weekends. Statistically significant changes in cesarean section indications were, however, observed between the two investigated years, which may be attributed to an organizational change within the department toward more sophisticated obstetric care. These changes included a significant increase in cesarean sections for dystocia and breech presentation and a decrease for fetal distress and "other" indications. Because the total cesarean section rate did not change during the study periods, it is suggested that modern obstetric practice per se does not increase cesarean section rates, but may shift the distribution of indications for cesarean section.
通过比较1979年和1980年剖宫产的指征，并根据一周中的日期调查指征分布情况，对医生在决定进行剖宫产时的偏见的各个方面进行了研究。通过显示非选择性剖宫产指征在工作日和周末之间的分布没有差异，反驳了产科医生可能在周末进行剖宫产以获取次要利益的观点。然而，在两个被调查的年份之间观察到剖宫产指征有统计学上的显著变化，这可能归因于该部门内部朝着更复杂的产科护理方向的组织变革。这些变化包括难产和臀位剖宫产显著增加，胎儿窘迫和“其他”指征的剖宫产减少。由于在研究期间剖宫产总率没有变化，因此表明现代产科实践本身不会增加剖宫产率，但可能会改变剖宫产指征的分布。
