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Association of Obstetrician Gender With Obstetric Interventions and Outcomes

Yee, Lynn M., MD, MPH; Miller, Emily S., MD, MPH

doi: 10.1097/AOG.0000000000002676
Contents: Obstetrics: Original Research

OBJECTIVE: To estimate whether there are differences in obstetric interventions or outcomes by the gender of the delivering physician.

METHODS: We conducted a retrospective cohort study of all nulliparous women delivering singleton, vertex, live births at 37 weeks of gestation or greater at a tertiary care institution (2014–2015). Patient clinical characteristics were analyzed by delivering physician gender. The primary outcomes were delivery mode and episiotomy. Secondary outcomes included major perineal laceration, postpartum hemorrhage, 5-minute Apgar score less than 7, cord umbilical artery pH less than 7.0, and neonatal intensive care unit admission. Univariable and hierarchical multivariable analyses including physician as a random effect were utilized for analyses.

RESULTS: Of the 7,027 women who met inclusion criteria, 81.3% (n=5,716) were delivered by a female physician. Women delivered by female physicians were slightly younger than those delivered by male physicians and were more likely to be publicly insured (11.7% vs 7.1%, P<.001). Mode of delivery did not differ by physician gender; the cesarean delivery rate was 20.6% for male physicians and 20.5% for female physicians (P=.61). Although the episiotomy rate did differ by physician gender, with 5.9% of patients delivered by male physicians undergoing episiotomy compared with 3.6% of patients delivered by female physicians (P=.001), this finding did not persist in the multivariable model after accounting for potential confounders (adjusted odds ratio 0.87, 95% CI 0.49–1.56). There were no differences by physician gender regarding any of the examined secondary outcomes in univariable or multivariable analyses.

CONCLUSION: Outcomes of nulliparous women undergoing a trial of labor did not differ by delivering physician gender.

Obstetric interventions and maternal and neonatal adverse outcomes among nulliparous women undergoing a trial of labor do not differ by the delivering physician's gender.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Corresponding author: Lynn M. Yee, MD, MPH, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2191, Chicago, IL 60611; email:

Lynn M. Yee and Emily S. Miller were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development K12 HD050121-11 and K12 HD050121-09, respectively, at the time of the study. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that she has met the journal's requirements for authorship.

Received January 8, 2018. Received in revised form March 7, 2018. Accepted March 15, 2018.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.