The effect of family physician timing of maternal admission on procedures in labour and maternal and infant morbidity

Abstract

Objective: To determine if a family physician practice pattern of early admission is associated with increased rates of intervention in labour and delivery, and/or adverse maternal and newborn outcomes.

Method: A retrospective cohort study compared women under the care of family physicians having 50% or more of their patients admitted to the labour and delivery unit "early" (defined as a cervical dilatation of < or =3 cm) to women under the care of family physicians having less than 50% of their patients admitted "early." Outcome measures included labour intervention rates and maternal and neonatal morbidity.

Results: After adjusting for maternal characteristics, care by family physicians with a practice of early admission was associated with increased rates of electronic fetal monitoring (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.27-1.89), epidural analgesia (OR, 1.34; 95% CI, 1.15-1.55), and Caesarean section (OR, 1.33; 95% CI, 1.00-1.65) compared to family physicians with a practice pattern of late admission. Malposition in labour was associated with more interventions in labour than was family physician practice pattern.

Conclusion: Women under the care of family physicians with a practice pattern of early admission were more likely to receive electronic fetal monitoring, epidural analgesia, and Caesarean section than women under the care of family physicians with a practice pattern of late admission. Malposition in labour had a greater effect on procedure use than any other variable in our model.