Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Healthcare Quality Improvement

Background:

• Cesarean birth rates in the US exceed optimal levels, contributing to maternal mortality and healthcare costs.
• Healthy People 2020 aims for a nulliparous, term, singleton, vertex (NTSV) cesarean rate of no more than 23.9%.
• Wide variations in NTSV cesarean rates exist across US hospitals and individual providers, unexplained by clinical factors.

Purpose of the Study:

• To investigate the association between healthcare providers' attitudes towards birth and their low-risk primary cesarean rates.
• To determine if differing provider attitudes contribute to practice variations in cesarean birth rates.

Main Methods:

• A stratified random sample of 400 California intrapartum care providers (obstetricians, family physicians, midwives) were surveyed on birth attitudes.
• Providers' NTSV cesarean birth rates for 2013-2014 were collected.
• Adjusted multivariate Poisson and linear regression models were used to analyze the association between attitudes and cesarean rates, controlling for covariates.

Main Results:

• A composite attitude score was significantly associated with providers' NTSV cesarean rates (IRR 1.21 per one-point increase).
• Providers meeting the Healthy People 2020 goal demonstrated significantly more favorable attitudes towards vaginal birth compared to those who did not (p < 0.01).

Conclusions:

• Differences in provider attitudes towards birth are linked to variations in NTSV cesarean rates.
• Healthcare providers with attitudes more favorable to vaginal birth are associated with lower cesarean rates.
• Addressing provider attitudes may offer a modifiable strategy for quality improvement initiatives aimed at reducing low-risk primary cesarean births.