What about the babies? There was no statistically significant difference in the current study between APGAR scores at the 2 hospitals, indicating that the increased cesarean delivery rate at the tertiary-care center did not produce improved short-term infant outcomes for the low-risk patients as assessed by this one parameter. This is an often-repeated story. Other studies that have examined other parameters have shown that term, normal birthweight infants can have better outcomes at community hospitals than at tertiary-care centers, possibly related to the effect of the previously mentioned physician and institutional factors on their mother’s intrapartum care.11-13
Conclusions
Janssen and colleagues make us think about our role as family physicians who provide maternity care and about what our patients should know. Although family physicians do have important maternity care roles in tertiary care centers as care providers, teachers, and role models, most of us provide care in community hospital settings. Although family physicians deliver approximately 20% of the babies in the United States, we deliver a much larger portion in smaller communities and are the main maternity care providers in rural areas. Providing this access is very important, since we know that pregnancy outcomes are poorer when maternity care is not available locally and women must travel for that care.14,15 Modern medicine has fostered a “bigger is better” mentality, but this study and others like it provide evidence that where hospitals are concerned size matters in an unexpected way: Low-risk women and their babies may be better off in community hospitals than in tertiary-care centers.