How do demographic variables affect pregnant women’s perceptions of obstetrics forceps: a cross sectional study

Abstract

Background Women’s attitudes towards obstetric forceps likely contribute to declining use and opportunities for residency training, but formal documentation of women’s attitudes towards obstetric forceps is currently limited. A clearer understanding should help guide our attempts to preserve its use in modern obstetrics and to improve residency training. Our objective is to document women’s attitudes towards obstetric forceps and the influence basic demographic variables have on those attitudes. Methods A cross sectional study was performed. We developed a one-time anonymous structured 5-question survey that was given to all low-risk patients presenting to our medical center for prenatal care between October 2018 - December 2018. The questionnaire asked for the patient’s self-reported age, race, education level, and insurance type. The five questions were as follows: (1) Do you think forceps should be use to deliver babies, (2) Are forceps safe for the baby, (3) Are forceps safe for the mother, (4) Do you think forceps can help to lower the cesarean section rate, (5) Do you think training physicians should learn to place forceps on a live-model. We calculated the means and proportions for the responses according to the overall group and various subgroups. Statistical analysis included Kruskall Wallis, Mann-Whitney tests as appropriate. Results were also adjusted by regression using a Generalized Linear Model. The power calculation showed the sample size required was 384. Results A total of 499 patients returned the questionnaire. The response rate was 56.8% (499/878). The findings suggest that patient perceptions towards forceps are generally negative. Women with white ethnicity, college education or higher, and private insurance did have more favorable views than their counterparts, but the majority still had unfavorable views. Age was not shown to have a significant effect on maternal attitude. Conclusion Women’s views towards forcep use at the University of Kansas Medical Center are negative and may be contributing to the decline of forcep use. Improving patient perception of forceps would require multiple different strategies rather than a single focused easily-implemented message. If forceps training continues, such training will rely on a minority of women who will accept forceps use in their delivery.