The Attitudes and Beliefs of Australian Midwives and Obstetricians About Birth Options and Labor Interventions

Abstract

Introduction The global rise in the rate of induction of labor and cesarean birth shows considerable unexplained variation both within and between countries. Prior research suggests that the extent to which women are engaged in the decision‐making process about birth options, such as elective cesarean, induction of labor, or use of fetal monitoring, is heavily influenced by clinician beliefs and preferences. The aim of this study was to investigate the beliefs about labor interventions and birth options held by midwives and obstetric medical staff from 8 Sydney hospitals and assess how the health care providers’ beliefs were associated with discipline or years of experience. Methods This is a survey study of midwives and obstetric staff that was distributed between November 2018 and July 2019. Modified from the previously validated birth attitudes survey for the Australian context, survey domains include (1) maternal choice and woman's role in birth, (2) safety by mode or place of birth, (3) attitudes toward cesarean birth for preventing urinary incontinence, (4) approaches to decrease cesarean birth rates, and (5) fears of birth mode. Responses were compared between professions and within professions by years of experience using Mann‐Whitney U testing. Results A total of 217 midwives and 58 medical staff completed the survey (response rate, 30.5%). Midwifery staff responses generally favored a physiologic approach to birth, versus beliefs more in favor of intervention (particularly cesarean birth) among medical staff. There was interprofessional discrepancy on most items, particularly regarding safety of mode or place of birth and approaches to decrease cesarean birth rates. Within disciplines, there was more variation in medical staff attitudes than within the midwifery staff. No clinically important differences in beliefs by years of experience were noted. Discussion Clinicians need to be aware of their own beliefs and preferences about birth as a potential source of bias when counselling women, particularly when there are a range of treatment options and the evidence may not strongly favor one option over another. As both groups had similar perceptions about the importance of women's autonomy, shared decision‐making training could help bridge belief gaps and improve care around birth decisions.

Validação de escala para mensurar a carga de trabalho das parteiras

“…O primeiro fator é referente ao aumento no número de processos agendados, como cesarianas eletivas, versões cefálicas externas e induções ao parto; isso é consistente com a atual pesquisa baseada em evidências. (21,(23)(24)(25) E o segundo fator depende do tipo de paciente atendida, como a etnia subamericana, as nulíparas e as mulheres que apresentam comorbidades médico-obstétricas. Esse aumento da carga de trabalho observado é consistente com os achados de outros estudos, (1,2,8,21,23) pois atualmente enfrentamos um aumento na atenção aos processos crônicos, gerados pelo aumento da gemelaridade, pelo aumento da idade materna, pelos nascimentos prematuros, bem como pelo aumento das técnicas de reprodução assistida.…”

The effect of organizational belonging and profession on cliniciansʼ attitudes toward supporting vaginal birth and interprofessional teamwork—a cross‐sectional study

“…Midwives in this study were overall more supportive of strategies proposed to support vaginal birth and of organizational initiatives to reduce the CS rate than both physicians and nurse assistants. Differences in attitudes between midwives and physicians are known from previous research and has mainly been attributed to different care perspectives 24 . In general, midwives adhere more to the salutogenic perspective, 25 while physicians are generally more prone to see the inherent risks related to pregnancy and birth 26 .…”

“…26 Many of the items included in best practices reflect strategies that midwives believe in, such as providing more midwifery services and implementing a program that supports early labor at home. 24,27 Furthermore, the interaction effect seen for the subscales was mainly related to midwives, physicians and nurse assistants at two labor wards; Karolinska Huddinge and Linköping. The interaction effect was most accentuated for the subscale unpredict- e Effect size according to Cohen: Small effect = 0.01, Medium effect = 0.06, Large effect = 0.14.…”

“…Differences in attitudes between midwives and physicians are known from previous research and has mainly been attributed to different care perspectives. 24 In general, midwives adhere more to the salutogenic perspective, 25 while physicians are generally more prone to see the inherent risks related to pregnancy and birth. 26 Many of the items included in best practices reflect strategies that midwives believe in, such as providing more midwifery services and implementing a program that supports early labor at home.…”

Feelings of being a second victim among Spanish midwives and obstetricians

“…This topic has been studied in obstetric professionals in some countries, both among midwives (Kerkman et al, 2019 ) (Buhlmann et al, 2021 ) and obstetric physicians (Baas et al, 2018 ; Torbenson et al, 2021 ), but there are still few studies investigating in depth the possible differences with respect to this phenomenon between the two professions (Rivera‐Chiauzzi et al, 2021 ; Schrøder et al, 2019 ; Wahlberg et al, 2017 ). Although both perform their professional work in the same health field, often working as a team, they are different professions and consequently have different connotations (Coates et al, 2021 ).…”