Does the attending obstetrician influence the mode of delivery in the `standard' nullipara?

Abstract

We have investigated whether the attending obstetrician has an influence on the mode of operative delivery by examining practices of obstetricians working at a district general hospital in the United Kingdom over 3 years. Nulliparous women ( n = 1410) with a singleton, cephalic and term fetus who had an operative delivery were studied. The most senior obstetrician present at 89% of these deliveries was one of the 12 registrars training in the unit. The proportion of women delivered by each mode of vaginal or abdominal operative delivery by each registrar was compared. In nine of these registrars the proportion of women they delivered by at least one mode differed significantly from the others. Caesarean section after an unsuccessful attempt at operative vaginal delivery showed the largest variation and caesarean section before the second stage of labour showed the least, with vaginal operative delivery modes and caesarean section in the second stage without a trial of vaginal delivery intermediate between the two. The method can be used to provide a 'profile' of the preferences exercised by individual operators.