Expectant mothers are likely to opt for an obstetrician to deliver their child over a family doctor, with the assumption that because an obstetrician is more specialized, there is lower risk of birth complications. However, a new study finds that for low-risk pregnancies, this is not the case.
Published in the Canadian Medical Association Journal (CMAJ), the study found no difference in the risk of newborn death, maternal death or other maternal complications between low-risk deliveries carried out by family doctors or obstetricians.
According to study co-author Dr. Kris Aubrey-Bassler, of Memorial University of Newfoundland in Canada, and colleagues, previous studies have confirmed that for pregnant women at high risk of birth complications, delivery by obstetricians is beneficial for both mothers and their infants.
However, the team notes that for low-risk pregnancies, the evidence is less clear on whether the risk of birth complications is lower with delivery by obstetricians than with family physicians.
“Most prior studies have concluded that obstetric outcomes between family physicians and obstetricians are similar, but many of these studies were small, and none of them adjusted for unmeasured factors that might affect both the choice of delivery provider and outcomes,” say the authors.
Dr. Aubrey-Bassler and colleagues set out to investigate further, analyzing data from 799,823 births that took place in over 390 hospitals in Canada between 2006 and 2009.
Among these births, the team identified 3,600 newborn deaths – defined as in-hospital death after 20 weeks’ gestation – and 14,394 cases of maternal death or other adverse complications, such as eclampsia, peritonitis and sepsis during labor.
A “multivariable logistic regression and instrumental variable-adjusted multivariable regression” technique was applied to the data, enabling the researchers to assess how birth outcomes differed between delivery by obstetricians and family doctors, while also accounting for unmeasured factors – such as the severity of a mother’s diabetes, for example.
The results of the analysis revealed that the occurrence of newborn death, maternal death or other maternal complications were similar between deliveries carried out by family physicians and those conducted by obstetricians.
The team says because of the analytical method applied to the data, their findings only apply to mothers and infants who are at low risk for complications and, as a result, would be eligible for delivery by family physician or obstetrician.
They stress that expectant mothers at high risk for birth complications should continue to be referred to obstetricians for delivery.
Commenting on their findings, the authors say:
“After 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.”
The researchers say that future research should investigate how different delivery providers affect other delivery outcomes for infants, noting that their study only accounted for infant death.
“Infants may benefit in other ways from delivery by obstetricians or family physicians, particularly the lower-risk infant population in whom the risk of death is very low,” they add.
Last year, a Spotlight from Medical News Today investigated different birthing methods for expectant mothers and assessed the risks associated with each one.