Physician experience and the use of forceps in a university hospital: A retrospective cohort study

OBJECTIVE: To evaluate the association between physician experience and the use of forceps-assisted vaginal delivery, and to assess whether increasing experience is associated with changes in cesarean delivery rates in a tertiary academic health care network. METHODS: We conducted a retrospective longitudinal cohort study including all physician-attended deliveries within a tertiary academic healthcare network in Santiago, Chile, between 2014 and 2024. The unit of analysis was the physician-year. Physician experience was defined as years since completion of residency and analyzed as a continuous variable. Outcomes included forceps-assisted and cesarean deliveries, modeled using volume-weighted logistic regression at the physician-year level. A sensitivity analysis restricted the data set to physician-years with ≥20 deliveries. RESULTS: The data set included 109 physicians, 641 physician-year observations, and 26 898 deliveries. Cesarean delivery accounted for 46.05%, spontaneous vaginal delivery for 46.18%, and forceps-assisted delivery for 7.75%. Increasing physician experience was associated with higher odds of forceps delivery (odds ratio [OR] per year, 1.013 [95% confidence interval [CI], 1.008-1.018]; p < 0.001). Although a statistically significant association was observed for cesarean delivery (OR per year, 1.007 [95% CI, 1.005-1.010]; p < 0.001), the magnitude was minimal and not clinically meaningful. Findings were consistent in the ≥20-delivery sensitivity analysis. CONCLUSION: Increasing physician experience is associated with greater use of forceps-assisted delivery, while cesarean delivery rates remain largely unchanged. These findings suggest that operative vaginal delivery depends on sustained clinical exposure, and preserving training opportunities may help maintain its role as an alternative to cesarean delivery in appropriately selected patients.