ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2015
Outcomes of deliveries by family physicians or obstetricians: a population-based cohort study using an instrumental variable.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 24 citations in OpenAlex.
- The Geographic Distribution of Family Physicians Providing Maternity Care and Opportunities for Expanding Access to Care in Rural Areas.Annals of family medicine · 2025Article
- Family physicians' perspectives on advising patients on an obstetric delivery location: Study from a remote community.Canadian family physician Medecin de famille canadien · 2025Article
- The value of family medicine: An impossible job, done impossibly well.Canadian family physician Medecin de famille canadien · 2023Article
- Le paysage changeant des soins obstétricaux au Canada.Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2020Article
- The problems of smaller, rural and remote hospitals: Separating facts from fiction.Future healthcare journal · 2020Article
- Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States.PloS one · 2020Article
- Is attending birth dying out? Trends in obstetric care provision among primary care physicians in British Columbia.Canadian family physician Medecin de famille canadien · 2019Article
- Use of real-world evidence from healthcare utilization data to evaluate drug safety during pregnancy.Pharmacoepidemiology and drug safety · 2019Review
- Effect of implementation of the MOREBMC pregnancy and childbirth · 2019Article
- Understanding the Allocation of Caesarean Outcome to Provider Type: A Chart Review.Healthcare policy = Politiques de sante · 2018Article
- Challenges Faced by Family Physicians Providing Advanced Maternity Care.Maternal and child health journal · 2018Article
- Cesarean delivery rates among family physicians versus obstetricians: a population-based cohort study using instrumental variable methods.CMAJ open · 2017Article
- Computed tomography during initial management and mortality among hemodynamically unstable blunt trauma patients: a nationwide retrospective cohort study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2017Article
- Family Medicine Obstetrics: Answering the Call.Annals of family medicineArticle
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrevious research has suggested that obstetric outcomes are similar for deliveries by family physicians and obstetricians, but many of these studies were small, and none of them adjusted for unmeasured selection bias. We compared obstetric outcomes between these provider types using an econometric method designed to adjust for unobserved confounding.
methodsWe performed a retrospective population-based cohort study of all Canadian (except Quebec) hospital births with delivery by family physicians and obstetricians at more than 20 weeks gestational age, with birth weight greater than 500 g, between Apr. 1, 2006, and Mar. 31, 2009. The primary outcomes were the relative risks of in-hospital perinatal death and a composite of maternal mortality and major morbidity assessed with multivariable logistic regression and instrumental variable-adjusted multivariable regression.
resultsAfter exclusions, there were 3600 perinatal deaths and 14,394 cases of maternal morbidity among 799,823 infants and 793,053 mothers at 390 hospitals. For deliveries by family physicians v. obstetricians, the relative risk of perinatal mortality was 0.98 (95% confidence interval [CI] 0.85-1.14) and of maternal morbidity was 0.81 (95% CI 0.70-0.94) according to logistic regression. The respective relative risks were 0.97 (95% CI 0.58-1.64) and 1.13 (95% CI 0.65-1.95) according to instrumental variable methods.
interpretationAfter adjusting for both observed and unobserved confounders, we found a similar risk of perinatal mortality and adverse maternal outcome for obstetric deliveries by family physicians and obstetricians. Whether there are differences between these groups for other outcomes remains to be seen.
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