Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based study

Abstract

Objective We compared processes of antepartum, intrapartum and postpartum care and obstetrical outcomes between physicians and non-physicians.Design This is a population-based retrospective matched cohort study.Setting The study was conducted in Ontario, Canada.Participants Physicians and non-physicians residing in high-income urban areas from 1 April 2009 to 26 November 2018 were included. Physicians were matched to non-physicians on maternal age, calendar year, parity, conception by assisted reproductive technology and singleton versus multifetal gestation. We compared processes of antepartum, intrapartum and postpartum care between physicians and non-physicians.Outcome measures The primary outcome was mode of delivery (caesarean section, C-section vs vaginal delivery). Secondary outcomes included obstetrical anal sphincter injury among those experiencing vaginal birth and differences in urgent healthcare contacts (maternal and neonatal) during the postpartum period.Results 7327 physicians were matched 1:5 to 36 185 non-physicians and were well balanced except for comorbidities (physicians had fewer comorbidities). Physicians had more antenatal ultrasounds and invasive prenatal testing, received labour anaesthesia more often and were more often delivered by their own care provider. In adjusted analyses, physicians and non-physicians had a similar risk of C-section (aRR 0.97, 95% CI 0.93 to 1.00, p=0.07). There was no difference in neonatal urgent care contacts; non-physicians had a higher risk of maternal urgent postpartum care (adjusted relative risk [aRR] 1.22, 95% CI 1.08 to 1.37, p<0.0001).Conclusions Physicians and non-physicians of similar age and with similar pregnancy characteristics had a comparable rate of C-section, which may be related to a lack of cost drivers for C-section in Ontario.