Relationship between obstetricians’ cognitive and affective traits and delivery outcomes among women with a prior cesarean

Yee, Lynn M.; Liu, Lilly Y.; Grobman, William A.

doi:10.1016/j.ajog.2015.05.023

Cited by 41 publications

(37 citation statements)

References 27 publications

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“…A study showed that the likelihood of undergoing a VBAC was increased in women cared for by obstetricians with low levels of anxiety [9]. Dahlen [34] emphasised that an important part of professional competence is achieving the balance between a fear of complications and a faith in the birthing process.…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of a robust justification of these increasing rates, an exploration of clinicians’ attitudes to CS as a mode of birth is required [2, 5–7], since an understanding of the non-medical factors associated with the decision to perform a CS are becoming more important. These factors include maternal requests [8] and provider attitudes [9]. …”

Section: Introductionmentioning

confidence: 99%

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Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates

Lundgren

Healy

Carroll

et al. 2016

BMC Pregnancy Childbirth

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BackgroundCaesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of “OptiBIRTH”, an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.MethodsFocus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.ResultsThe findings are presented in four main categories with several sub-categories: 1) “prameters for VBAC”, including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) “organisational support and resources for women undergoing a VBAC”, meaning a successful VBAC requires clinical expertise and resources during labour; 3) “fear as a key inhibitor of successful VBAC”, including understanding women’s fear of childbirth, clinicians’ fear of VBAC and the ways that clinicians’ fear can be transferred to women; and 4) “shared decision making – rapport, knowledge and confidence”, meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician–woman relationship.ConclusionsThe findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates

Lundgren

Healy

Carroll

et al. 2016

BMC Pregnancy Childbirth

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“…8 Night float providers were those who practiced in a group where the on-call night obstetrician provided hospital care for several nights sequentially without daytime office or other clinical responsibilities. Groups had different numbers of sequential nights in a night float system, but all providers categorized as night float were those whose only clinical responsibility was for hospitalized patients in either a day or night shift; shifts were followed by time for sleep prior to a subsequent shift.…”

Section: Methodsmentioning

confidence: 99%

“…6-8 One potential provider factor that may influence delivery approach is the type of call schedule, or the manner in which a physician's group handles nighttime hospital responsibilities. Prior work by Barber et al found that the transition from a traditional call schedule to a night float system was associated with changes in practice patterns at the time of delivery.…”

Section: Introductionmentioning

confidence: 99%

Obstetrician call schedule and obstetric outcomes among women eligible for a trial of labor after cesarean

Yee

Liu

Grobman

2017

American Journal of Obstetrics and Gynecology

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BACKGROUND Reducing cesarean deliveries is a major public health goal. The low rate of vaginal birth after cesarean (VBAC) has been attributed largely to a decrease in likelihood of choosing a trial of labor after cesarean (TOLAC), despite evidence suggesting a majority of women with one prior low transverse cesarean are TOLAC candidates. While a number of reasons for this decrease have been explored, it remains unclear how systems issues such as physician call schedules influence delivery approach and mode in this context. OBJECTIVE To investigate the relationship between obstetricians’ call schedule and obstetric outcomes among women eligible for a TOLAC. STUDY DESIGN This is a retrospective cohort study of likelihood of attempting TOLAC and achieving VBAC among women with one prior low transverse cesarean delivery and a term, cephalic singleton gestation based on delivering provider's call schedule. Attending obstetrician call schedules were classified as traditional or “night float” call. Night float call was defined as a schedule in which the provider only had clinical responsibilities for a day or night shift, without other clinical responsibilities before or after the period of responsibility for laboring patients. Call schedules are determined by individual provider groups. Bivariable analyses and random effects logistic regression were used to examine the relationship between obstetricians’ call schedule and the frequency of TOLAC. Secondary outcomes including frequency of VBAC and maternal and neonatal outcomes also were assessed. RESULTS Of 1502 eligible patients, 556 (37%) were delivered by physicians in a night float call system. 22.6% underwent TOLAC and 12.8% achieved VBAC; the VBAC rate for women attempting TOLAC was 56.5%. Women were more likely to undergo TOLAC (33.1% vs. 16.5%, p<0.001) and achieve VBAC (18.7% vs. 9.3%, p<0.001) when cared for by physicians with a night float call schedule. Regression analysis demonstrated physicians with a night float call schedule remained significantly more likely to have patients undergo TOLAC (aOR 2.64, 95% CI 1.65-4.25) and experience VBAC (aOR 2.17, 95% CI 1.36-3.45) after adjusting for potential confounders. However, the likelihood of achieving VBAC if TOLAC was attempted was not different based on provider call type (aOR 0.96, 95% CI 0.57-1.62). Although women delivered by providers with a night float schedule were more likely to experience uterine rupture (1.8% vs. 0.6%, p=0.03), chorioamnionitis (4.3% vs. 1.7%, p=0.002), postpartum hemorrhage (7.6% vs. 4.8%, p=0.03), and neonates admitted to the NICU (6.8% vs 3.9%, p=0.01), these associations did not persist when the population was limited to women attempting TOLAC. CONCLUSIONS While physicians working on a night float call system were significantly more likely to have patients with a prior cesarean undergo TOLAC and achieve VBAC, their patients also were more likely to experience maternal and neonatal morbidity. However, these differences did not persist when limiting analyses to women att...

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“…Yee and colleagues demonstrated that lower physician anxiety levels and more proactive coping were associated with higher rates of trial of labor after cesarean and successful vaginal birth after cesarean when managing women with a prior cesarean delivery. 11 Further exploration of how specific physician traits affect outcomes is warranted. Ultimately interventions to assist with modification of behavior in clinical scenarios may help to reduce the cesarean delivery rate and influence patient outcomes.…”

Section: Commentmentioning

confidence: 99%

Variation in primary cesarean delivery rates by individual physician within a single-hospital laborist model

Metz

Allshouse

Gilbert

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Laborist practice models are associated with lower cesarean delivery rates than individual private practice models in several studies; however, this effect is not uniform. Further exploration of laborist models may help us better understand the observed reduction in cesarean delivery rates in some hospitals with implementation of a laborist model. Objective Our objective was to evaluate the degree of variation in primary cesarean delivery rates by individual laborists within a single institution employing a laborist model. In addition, we sought to evaluate whether differences in cesarean delivery rates resulted in different maternal or short-term neonatal outcomes. Study Design At this teaching institution, one laborist (either a generalist or maternal-fetal medicine attending physician) is directly responsible for labor and delivery management during each shift. No patients are followed in a private practice model nor are physicians incentivized to perform deliveries. We retrospectively identified all laborists who delivered nulliparous, term women with cephalic singletons at this institution from 2007-14. Overall and individual primary cesarean delivery rates were reported as percentages with exact Pearson 95% CI. Laborists were grouped by tertile as having low, medium or high cesarean delivery rates. Characteristics of the women delivered, indications for cesarean delivery, and short-term neonatal outcomes were compared between these groups. A binomial regression model of cesarean delivery was estimated, where the relative rates of each laborist compared to the lowest-unadjusted laborist rate were calculated; a second model was estimated to adjust for patient-level maternal characteristics. Results Twenty laborists delivered 2,224 nulliparous, term women with cephalic singletons. The overall cesarean delivery rate was 24.1% (95% CI 21.4-26.8). In an unadjusted binomial model, the overall effect of individual laborist was significant (p<0.001), and a 2.9 fold (1.5, 5.4, p=0.001) variation between the cesarean delivery rates of the highest (35.9%) and lowest (12.5%) physicians was observed. When adjusted for hypertensive disease, gestational age at delivery, race, and maternal age, the physician effect remained overall significant (p=0.0265) with the difference between physicians expanding to 3.58 (1.72-7.47, p<0.001). Between groups of laborists with low, medium, and high cesarean delivery rates, patient demographics and clinical characteristics of the population managed were clinically similar and not different statistically. The primary indication for cesarean delivery did not differ between groups. Similarly there were no differences in short-term neonatal outcomes including Apgar scores, arterial cord blood pH or incidence of neonatal encephalopathy. Conclusion The 3-fold variation in cesarean delivery rates between laborists at the same institution without observed differences in patient characteristics or short-term neonatal outcomes draws attention to the impact of individual physic...

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Relationship between obstetricians’ cognitive and affective traits and delivery outcomes among women with a prior cesarean

Cited by 41 publications

References 27 publications

Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates

Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates

Obstetrician call schedule and obstetric outcomes among women eligible for a trial of labor after cesarean

Variation in primary cesarean delivery rates by individual physician within a single-hospital laborist model

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