Michael C Klein1, Janusz Kaczorowski2, Wendy A Hall3, William Fraser4, Robert M Liston5, Sahba Eftekhary6, Rollin Brant7, Louise C Mâsse8, Jessica Rosinski9, Azar Mehrabadi10, Nazli Baradaran11, Jocelyn Tomkinson11, Sharon Dore12, Patricia C McNiven13, Lee Saxell14, Kathie Lindstrom15, Jalana Grant16, Aoife Chamberlaine17. 1. Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Family Practice, University of British Columbia, Vancouver BC; Department of Pediatrics, University of British Columbia, Vancouver BC. 2. Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Family Practice, University of British Columbia, Vancouver BC. 3. School of Nursing, University of British Columbia, Vancouver BC. 4. Department of Obstetrics and Gynecology, Université de Montréal, Montreal QC. 5. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC. 6. Ministry of Health and Long Term Care, Government of Ontario, Toronto ON. 7. Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Statistics, University of British Columbia, Vancouver BC. 8. Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Pediatrics, University of British Columbia, Vancouver BC. 9. Department of Political Science, University of British Columbia, Vancouver BC. 10. School of Population and Public Health, University of British Columbia, Vancouver BC. 11. Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver BC. 12. Hamilton Health Sciences, Hamilton ON. 13. Midwifery Education Program, Department of Family Practice, McMaster University, Hamilton ON. 14. Department of Midwifery, BC Women's Hospital and Health Centre and St. Paul's Hospital, Vancouver BC. 15. Perinatal Program, Faculty of Health Sciences, Douglas College, New Westminster BC. 16. South Community Birth Program, Vancouver BC. 17. Midwifery Education Program, Ryerson University, Toronto ON.
Abstract
OBJECTIVE: Collaborative, interdisciplinary care models have the potential to improve maternity care. Differing attitudes of maternity care providers may impede this process. We sought to examine the attitudes of Canadian maternity care practitioners towards labour and birth. METHODS: We performed a cross-sectional web- and paper-based survey of 549 obstetricians, 897 family physicians (400 antepartum only, 497 intrapartum), 545 nurses, 400 midwives, and 192 doulas. RESULTS: Participants responded to 43 Likert-type attitudinal questions. Nine themes were identified: electronic fetal monitoring, epidural analgesia, episiotomy, doula roles, Caesarean section benefits, factors decreasing Caesarean section rates, maternal choice, fear of vaginal birth, and safety of birth mode and place. Obstetrician scores reflected positive attitudes towards use of technology, in contrast to midwives' and doulas' scores. Family physicians providing only antenatal care had attitudinal scores similar to obstetricians; family physicians practising intrapartum care and nurses had intermediate scores on technology. Obstetricians' scores indicated that they had the least positive attitudes towards home birth, women's roles in their own births, and doula care, and they were the most concerned about the consequences of vaginal birth. Midwives' and doulas' scores reflected opposing views on these issues. Although 71% of obstetricians supported regulated midwifery, 88.9% were against home birth. Substantial numbers of each group held attitudes similar to dominant attitudes from other disciplines. CONCLUSION: To develop effective team practice, efforts to reconcile differing attitudes towards labour and birth are needed. However, the overlap in attitudes between disciplines holds promise for a basis upon which to begin shared problem solving and collaboration.
OBJECTIVE: Collaborative, interdisciplinary care models have the potential to improve maternity care. Differing attitudes of maternity care providers may impede this process. We sought to examine the attitudes of Canadian maternity care practitioners towards labour and birth. METHODS: We performed a cross-sectional web- and paper-based survey of 549 obstetricians, 897 family physicians (400 antepartum only, 497 intrapartum), 545 nurses, 400 midwives, and 192 doulas. RESULTS:Participants responded to 43 Likert-type attitudinal questions. Nine themes were identified: electronic fetal monitoring, epidural analgesia, episiotomy, doula roles, Caesarean section benefits, factors decreasing Caesarean section rates, maternal choice, fear of vaginal birth, and safety of birth mode and place. Obstetrician scores reflected positive attitudes towards use of technology, in contrast to midwives' and doulas' scores. Family physicians providing only antenatal care had attitudinal scores similar to obstetricians; family physicians practising intrapartum care and nurses had intermediate scores on technology. Obstetricians' scores indicated that they had the least positive attitudes towards home birth, women's roles in their own births, and doula care, and they were the most concerned about the consequences of vaginal birth. Midwives' and doulas' scores reflected opposing views on these issues. Although 71% of obstetricians supported regulated midwifery, 88.9% were against home birth. Substantial numbers of each group held attitudes similar to dominant attitudes from other disciplines. CONCLUSION: To develop effective team practice, efforts to reconcile differing attitudes towards labour and birth are needed. However, the overlap in attitudes between disciplines holds promise for a basis upon which to begin shared problem solving and collaboration.
Authors: Michael C Klein; Janusz Kaczorowski; Jocelyn Tomkinson; Stephen Hearps; Nazli Baradaran; Rollin Brant Journal: Can Fam Physician Date: 2011-04 Impact factor: 3.275