Personal Birth Experiences and Clinician Attitudes About Cesarean Birth: A Cross-Sectional Study With Female Labor...

Increasing vaginal birth rates is a quality improvement goal in the United States, where nearly one-third of all births are cesarean deliveries. Evidence from other clinical areas suggests that healthcare workers' experience as patients can influence their clinical attitudes. This study explores whether personal birth experiences of labor and delivery unit staff are associated with attitudes regarding hospital labor culture and care practices.

We conducted a cross-sectional survey of female labor and delivery staff at 29 Arkansas hospitals. Using multilevel linear models, we estimated the association between staff's personal birth experiences and their attitudes across six subscales of the validated Labor Culture Survey (LCS).

Survey data from 378 female labor and delivery staff (nurses, 90.2%; physicians, 9.8%) with different personal birth experience (vaginal only, 49.2%; cesarean only, 20.6%; both vaginal and cesarean, 9.3%; no experience, 20.0%) were analyzed. Compared to staff with vaginal births only, average individual scores for staff who had cesarean births were significantly less supportive of vaginal birth for four Labor Culture Survey subscales: cesarean safety (p < 0.05), best practices to reduce cesarean overuse (p < 0.001), physician oversight (p < 0.001) and fear of vaginal birth (p < 0.001).

Directly addressing personal birth experiences of labor and delivery staff, such as through self-awareness education and reflection in trainings related to quality improvement efforts, may contribute to implementing practices that support vaginal birth. Further research is needed to elucidate the psychosocial mechanisms through which personal birth experiences influence staff attitudes.