Obstetrical care in a prepaid cooperative: a comparison between family practice residents, family physicians, and obstetricians.

The purpose of this study was to compare the obstetrical care provided by three different groups of physicians. Deliveries between July 1975 and July 1977 were tabulated and all 211 deliveries of the family physician (FP) group, and all 199 of the family practice residency (FPR) group were reviewed, as were a randomly selected group of 193 obstetrician (OB) deliveries. All hospital charts were reviewed for 81 variables. The FPR group had more patients who were poor, single, and nulliparous. They presented later in pregnancy, were more often anemic, and had an increased incidence of venereal disease. The FPR and FP groups documented major psychological problems and depression more frequently. The obstetricians used caudal and epidural anesthesia more frequently, whereas the FP and FPR groups used more narcotics. Except for an increased incidence of third degree lacerations in the FP group, total maternal and fetal complications were few and similarly divided among the groups. The FPR and FP groups delivered 78 percent and the OB group 38 percent of their own patients. This paper is an addition to a limited literature base which deals with process and outcome of obstetrical care delivered by various provider groups and is unique in that the study was undertaken in a large prepaid group.