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. 2024 Sep-Oct;22(5):375-382.
doi: 10.1370/afm.3157.

Family Medicine Presence on Labor and Delivery: Effect on Safety Culture and Cesarean Delivery

Emily White VanGompel  1 , Lavisha Singh  2 , Francesca Carlock  2 , Claire Rittenhouse  3 , Kelli K Ryckman  4 , Stephanie Radke  5
Affiliations

Family Medicine Presence on Labor and Delivery: Effect on Safety Culture and Cesarean Delivery

Emily White VanGompel et al. Ann Fam Med. 2024 Sep-Oct.

Abstract

Purpose: Currently, 40% of counties in the United States do not have an obstetrician or midwife, and in rural areas the likelihood of childbirth being attended to by a family medicine (FM) physician is increasing. We sought to characterize the effect of the FM presence on unit culture and a key perinatal quality metric in Iowa hospital intrapartum units.

Methods: Using a cross-sectional design, we surveyed Iowa physicians, nurses, and midwives delivering intrapartum care at hospitals participating in a quality improvement initiative to decrease the incidence of cesarean delivery. We linked respondents with their hospital characteristics and outcomes data. The primary outcome was the association between FM physician, obstetrician (OB), or both disciplines' presence on labor and delivery and hospital low-risk, primary cesarean delivery rate. Unit culture was compared by hospital type (FM-only, OB-only, or Both).

Results: A total of 849 clinicians from 39 hospitals completed the survey; 13 FM-only, 11 OB-only, and 15 hospitals with both. FM-only hospitals were all rural, with <1,000 annual births. Among hospitals with <1,000 annual births, births at FM-only hospitals had an adjusted 34.3% lower risk of cesarean delivery (adjusted incident rate ratio = 0.66; 95% CI, 0.52-.0.98) compared with hospitals with both. Nurses endorsed unit norms more supportive of vaginal birth and stronger safety culture at FM-only hospitals (P <.05).

Conclusions: Birthing hospitals staffed exclusively by FM physicians were more likely to have lower cesarean rates and stronger nursing-rated safety culture. Both access and quality of care provide strong arguments for reinforcing the pipeline of FM physicians training in intrapartum care.

Keywords: cesarean birth; family medicine; organizational culture.

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References

    1. Berg CJ, Callaghan WM, Syverson C, Henderson Z.. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol. 2010; 116(6): 1302-1309. 10.1097/AOG.0b013e3181fdfb11 - DOI - PubMed
    1. Callaghan WM, Creanga AA, Kuklina EV.. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012; 120(5): 1029-1036. 10.1097/AOG.0b013e31826d60c5 - DOI - PubMed
    1. MacDorman MF, Thoma M, Declcerq E, Howell EA.. Racial and ethnic disparities in maternal mortality in the United States using enhanced vital records, 2016-2017. Am J Public Health. 2021; 111(9): 1673-1681. 10.2105/AJPH.2021.306375 - DOI - PMC - PubMed
    1. Kozhimannil KB, Interrante JD, Tuttle MKS, Henning-Smith C.. Changes in hospital-based obstetric services in rural US counties, 2014-2018. JAMA. 2020; 324(2): 197-199. 10.1001/jama.2020.5662 - DOI - PMC - PubMed
    1. Kozhimannil KB, Interrante JD, Henning-Smith C, Admon LK.. Rural-urban differences in severe maternal morbidity and mortality in the US, 2007-2015. Health Aff (Millwood). 2019; 38(12): 2077-2085. 10.1377/hlthaff.2019.00805 - DOI - PubMed