Do maternity care providers have different attitudes toward birth?

Faculty of Nursing, University of British Columbia, Vancouver, BC, Canada.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 01/2005; 111(12):1388-93. DOI: 10.1111/j.1471-0528.2004.00338.x
Source: PubMed


To compare family physicians', obstetricians' and midwives' self-reported practices, attitudes and beliefs about central issues in childbirth.
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 = 50), 69% (n = 97) and 89% (n = 34), respectively.
A postal survey.
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.
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.
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.

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    • "This search yielded a single instrument, the Nurse Attitudes and Beliefs Questionnaire (NABQ). The NABQ is a Canadian instrument developed in conjunction with the Maternity Care Providers Attitudes and Beliefs (MCPAB) study (Reime et al., 2004). The original instrument for the MCPAB study was designed for use with physicians and midwives. "
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    ABSTRACT: Background and purpose: Labor/delivery nurse attitudes and beliefs may affect nursing care decisions and patient outcomes. This psychometric study was conducted to revise the Nurse Attitudes and Beliefs Questionnaire-Revised (NABQ-R). Methods: The NABQ-R contains 42 items scored with a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). An online survey invitation was sent to Colorado intrapartum nurses with 84 complete surveys returned. Results: The NABQ-R scores ranged from 82 to 156 and the Cronbach's alpha was .90. An exploratory factor analysis was conducted, and all items loaded on at least 1 factor. Conclusions: Our results support acceptable initial psychometric properties for the NABQ-R consistent with existing theory indicating that the NABQ-R shows promise for use in future studies.
    Journal of Nursing Measurement 08/2015; 23(2). DOI:10.1891/1061-3749.23.2.287
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    • "Not surprisingly, care providers and patients may value different components of health, which will give rise to different interpretations of risk. This is acutely evident in maternity care where there is continued dissonance in attitudes toward interventions in birth [46,47] and protocols such as induction for post-dates pregnancies [47]. In a rural environment with limited access to caesarean section services, the different values placed on the physical/mental/social dimensions of health have frequently led to a privileging of the medically defined course of care. "
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    ABSTRACT: Background A significant number of Canadian rural communities offer local maternity services in the absence of caesarean section back-up to parturient residents. These communities are witnessing a high outflow of women leaving to give birth in larger centres to ensure immediate access to the procedure. A minority of women choose to stay in their home communities to give birth in the absence of such access. In this instance, decision-making criteria and conceptions of risk between physicians and parturient women may not align due to the privileging of different risk factors. Methods In-depth qualitative interviews and focus groups with 27 care providers and 43 women from 3 rural communities in B.C. Results When birth was planned locally, physicians expressed an awareness and acceptance of the clinical risk incurred. Likewise, when birth was planned outside the local community, most parturient women expressed an awareness and acceptance of the social risk incurred due to leaving the community. Conclusions The tensions created by these contrasting approaches relate to underlying values and beliefs. As such, an awareness can address the impasse and work to provide a resolution to the competing prioritizations of risk.
    BMC Family Practice 11/2012; 13(1):108. DOI:10.1186/1471-2296-13-108 · 1.67 Impact Factor
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    • "Social norms and expectations, as well as prenatal discussions with health-care providers, may significantly impact women's choice of birth place (Hagelskamp et al., 2003; Allcock et al., 2008; Cheyney, 2008; Finsen et al., 2008; Lindgren et al., 2010). A provider's education, experience and scope of practice may have an impact on which options they will present to women related to choice of birth place (Floyd, 1995; Reime et al., 2004; Shaw and Kitzinger, 2005; Cheyney, 2008; Lindgren et al., 2010). Attitudes and beliefs particular to a professional culture may play a role in Table 5 Experience providing care for home birth transfers (n¼ 374). "
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    ABSTRACT: (1) to describe educational, practice, and personal experiences related to home birth practice among Canadian obstetricians, family physicians, and registered midwives; (2) to identify barriers to provision of planned home birth services, and (3) to examine inter-professional differences in attitudes towards planned home birth. the first phase of a mixed-methods study, a quantitative survey, comprised of 38 items eliciting demographic, education and practice data, and 48 items about attitudes towards planned home birth, was distributed electronically to all registered midwives (N=759) and obstetricians who provide maternity care (N=800), and a random sample of family physicians (n=3,000). Canada. This national investigation was funded by the Canadian Institutes for Health Research. Canadian registered midwives (n=451), obstetricians (n=245), and family physicians (n=139). almost all registered midwives had extensive educational and practice experiences with planned home birth, and most obstetricians and family physicians had minimal exposure. Attitudes among midwives and physicians towards home birth safety and advisability were significantly different. Physicians believed that home births are less safe than hospital births, while midwives did not agree. Both groups believed that their views were evidence-based. Midwives were the most comfortable with including planned home birth as an option when discussing choice of birth place with pregnant women. Both midwives and physicians expressed discomfort with inter-professional consultation related to planned home births. In addition, both family physicians and obstetricians reported discomfort with discussing home birth with their patients. A significant proportion of family physicians and obstetricians would have liked to attend a home birth as part of their education. the amount and type of education and exposure to planned home birth practice among maternity care providers were associated with attitudes towards home birth, comfort with discussing birth place options with women, and beliefs about safety. Barriers to home birth practice across professions were both logistical and philosophical. formal mechanisms for midwifery and medical education programs to increase exposure to the theory and practice of planned home birth may facilitate evidence based informed choice of birth place, and increase comfort with integration of care across birth settings. An increased focus among learners and clinicians on reliable methods for assessing the quality of the evidence about birth place and maternal-newborn outcomes may be beneficial.
    Midwifery 08/2012; 28(5):600-8. DOI:10.1016/j.midw.2012.06.011 · 1.57 Impact Factor
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