In December 2012, the Mount Sinai Hospital implemented a program to have senior obstetricians (more than 20 years of experience) supervise residents on labor and delivery during the daytime. The objective of this study was to estimate the association of resident supervision by senior obstetricians with mode of delivery.
This was a retrospective cohort study of all resident deliveries at Mount Sinai from July 2011 to June 2015. We included all patients with live, term, singleton, vertex fetuses. We compared delivery outcomes between patients delivered before December 2012 and patients delivered December 2012 and later using logistic regression analysis to control for age, body mass index, parity, induction, and prior cesarean delivery. During the study period there were no other specific departmental initiatives to increase forceps deliveries aside from having six obstetricians with significant experience in operative deliveries supervise and teach residents on labor and delivery.
There were 5,201 live, term, singleton, vertex deliveries under the care of residents, 1,919 (36.9%) before December 2012 and 3,282 (63.1%) December 2012 or later. The rate of forceps deliveries significantly increased from 0.6% to 2.6% (adjusted odds ratio [OR] 8.44, 95% confidence interval [CI] 3.1–23.1), and the rate of cesarean deliveries significantly decreased from 27.3% to 24.5% (adjusted OR 0.68, 95% CI 0.55–0.83). There were no statistically significant differences in the rates of third- or fourth-degree lacerations or 5-minute Apgar scores less than 7. Among nulliparous women, the forceps rate increased from 1.0% to 3.4% (adjusted OR 4.87, 95% CI 1.74–13.63) and the cesarean delivery rate decreased from 25.6% to 22.7% (adjusted OR 0.69, 95% CI 0.53–0.89). The increase in forceps deliveries and the decrease in cesarean deliveries were seen only in daytime hours (7 AM to 7 PM), that is, the shift that was covered by senior obstetricians.
Having senior obstetricians supervise resident deliveries is significantly associated with an increased rate of forceps deliveries and a decreased rate of cesarean deliveries.
Supplemental Digital Content is Available in the Text.Senior obstetrician supervision of resident deliveries is associated with a higher rate of forceps deliveries and a lower rate of cesarean delivery.
Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.
Corresponding author: Nathan S. Fox, MD, Maternal-Fetal Medicine Associates, PLLC, 70 East 90th Street, New York, NY 10128; email: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.
Presented as a poster at the Annual Scientific Meeting of the Society for Maternal-Fetal Medicine, January 23–28, 2017, Las Vegas, Nevada.
The authors acknowledge and thank Dr. George Arida, Dr. Katherine Chen, Dr. Marc Englebert, Dr. Lynn Friedman, Dr. Joyce Kim, and Dr. Rickie Penstein-Hirt as the senior obstetricians who participated in this departmental initiative.
Each author has indicated that he or she has met the journal’s requirements for authorship.