Do maternity care provider groups have different attitudes towards birth?

Abstract

Objective To compare family physicians', obstetricians' and midwives' self-reported practices, attitudes and beliefs about central issues in childbirth. Design Mail-out questionnaire.Setting/Population All registered midwives in the province, and a sample of family physicians and obstetricians in a maternity care teaching hospital. Response rates: 91% (n ¼ 50), 69% (n ¼ 97) and 89% (n ¼ 34), respectively. Methods A postal survey.Main outcome measures Twenty-three five-point Likert scale items (strongly agree to strongly disagree) addressing attitudes toward routine electronic fetal monitoring, induction of labour, epidural analgesia, episiotomy, doulas, vaginal birth after caesarean section (VBACs), birth centres, provision educational material, birth plans and caesarean section. Results Cluster analysis identified three distinct clusters based on similar response to the questions. The 'MW'cluster consisted of 100% of midwives and 26% of the family physicians. The 'OB' cluster was composed of 79% of the obstetricians and 16% of the family physicians. The 'FP' cluster was composed of 58% the family physicians and 21% the obstetricians. Members of the 'OB' cluster more strongly believed that women had the right to request a caesarean section without maternal/fetal indications (P < 0.001), that epidurals early in labour were not associated with development of fetal malpositions (P < 0.001) and that increasing caesarean rates were a sign of improvement in obstetrics (P < 0.001). The 'OB' cluster members were more likely to say they would induce women as soon as possible after 41 3/7 weeks of gestation (P < 0.001) and were least likely to encourage the use of birth plans (P < 0.001). The 'MW' cluster's views were the opposite of the 'OBs' while the 'FP' cluster's views fell between the 'MW' and 'OB' clusters. Conclusions In our environment, obstetricians were the most attached to technology and interventions including caesarean section and inductions, midwives the least, while family physicians fell in the middle. While generalisations can be problematic, obstetricians and midwives generally follow a defined and different approach to maternity care. Family physicians are heterogeneous, sometimes practising more like midwives and sometimes more like obstetricians.

Controversy between anesthesiologists and obstetricians on the labour ward: the Delphi method is used as a consensus-building technique

“…In contrast, many studies have addressed collaboration between nursing staff and physicians. 4,5 Primary care medicine has long recognized the need for interprofessional practice, with many models of highperformance teams. Several characteristics have been identified in high-performance teams, including effective communication, recognition of member contributions, shared decision-making, and shared vision and values.…”

“…Significantly different responses on knowledgebased questions showed that family practitioners and midwives were more skeptical about the external validity of the literature on issues such as induction of labour. 5 An independent inquiry into the safety of maternity services in England in 2008, ''Safe Births: Everybody's business'', concluded that ''safe teams'' are the key to improving the safety of maternity care. The inquiry found a number of recurrent difficulties in teamwork performance such as those related to interprofessional relationships, leadership and management, and communication.…”

A Comparison Between Swedish Midwives and Obstetricians & Gynecologists Opinions on Cesarean Section

“…Among the general public there is an agreement that women have the right to choose both on the basis of concern with bodily integrity and because of fear of childbirth (4). However, among professionals there are contradictory opinions (5,6).…”

“…During pregnancy the pregnant woman should be given adequate and balanced information on issues concerning mode of delivery and other health matters related to the delivery. Some studies have shown that there are differences in maternal caregivers opinions' on how they think one should deal with the woman's wishes and also on what might be an acceptable rate of cesarean section (5,6).…”

Attitudes towards mode of birth among Swedish midwives

“…Legal liability, for example, creates an awareness that has an impact on midwives as well as obstetricians and gynaecologist's decision-making and attitudes towards mode of delivery (Reime B et al 2004). Most studies have focused on obstetricians and gynaecologists' attitudes towards elective CS but little is known about midwives attitudes and opinions about CS.…”