A comparison of pregnancy care delivered by family physicians versus obstetricians in Lebanon

Abstract

Background: The provision of prenatal and intrapartum care is an important issue in family practice. Physician specialty as a risk factor for adverse perinatal outcome is of interest to both educators and patients. The purpose of this study is to compare perinatal care provided by family practice and obstetrics residents for low-risk women in Lebanon.

Methods: A study of 400 matched pairs of low-risk pregnant women was conducted at the American University of Beirut Medical Center to compare outcomes of perinatal care provided by family physicians and obstetricians. The medical records of women admitted for delivery at the American University of Beirut Medical Center between October 1, 1986, and October 1, 1990, were reviewed.

Results: Obstetricians used oxytocin induction significantly more frequently than family physicians (43% versus 7%, P < .01). A similar significant difference was also noted for artificial rupture of membranes. There were similar episiotomy rates (63%), with a greater number of lacerations reported among women cared for by obstetricians (28% versus 15%, P < .05). The use of forceps was similar in both groups. Vacuum extraction was not used by family physicians. Neonatal outcomes were comparable, although meconium-stained amniotic fluid was more common in the obstetrics group (21% versus 6%, P < .05). During the postpartum period, significantly more women breast-fed (62% versus 45%, P < .01) and used oral contraceptives in the family practice group.

Conclusions: When caring for low-risk pregnant women, family physicians appear to provide comparable care with less intervention than obstetricians.