No greater risk if physician delivers fewer babies

Conventional wisdom — based primarily on surgical practices — holds that the more times a physician completes a procedure, the better the outcome will be. However, in their study of all single births attended primarily by family physicians at a Vancouver teaching hospital, Michael Klein and colleagues found no association between adverse outcomes for mothers or newborns and family physicians who make few deliveries. The finding is important — the Society of Obstetricians and Gynaecologists of Canada and the College of Family Physicians of Canada, which had both maintained that attending a minimum of 24 births per year was required to maintain competence, have changed their position because of this study and other new evidence.

The authors divided physicians into 3 groups: low volume (fewer than 12 deliveries per year; 72 physicians, 549 births); medium volume (12-24 per year; 34 physicians, 871 births); and high volume (25 or more per year; 46 physicians, 3024 births). Both before and after adjusting for several maternal and infant characteristics, the authors found no difference among the 3 groups in terms of maternal complications of delivery, 5-minute Apgar scores below 7, or rates of admission of the infant to a special care unit. However, the authors did find that family physicians in the high- and medium-volume groups consulted obstetricians less frequently and were less likely to perform inductions than their low-volume counterparts.

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p. 1257 Does delivery volume of family physicians predict maternal and newborn outcome? — M.C. Klein et al

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