Factors influencing obstetricians' intentions to facilitate normal physiological birth: a qualitative study

Spontaneous vaginal birth is the preferred mode of birth for most women, however, increasing intervention has decreased rates, especially for nulliparous women. Obstetricians are identified as key stakeholders in intrapartum care, however very few studies have focused on the role obstetricians' intentions, attitudes and behaviours may have on mode of physiological birth. The purpose of this study was to explore factors influencing the intentions of obstetricians to facilitate normal physiological birth.

This qualitative study was underpinned by the Theory of Planned Behaviour. All participants were obstetricians, registered and practising within Australia, and had experience providing care to birthing women who met the 'selected primipara' criteria. Semi structured interviews were conducted with eight obstetricians representing various models of care across most States and Territories of Australia. Interviews were analysed using thematic analysis.

Two key themes were identified from the data, with three sub-themes nested within each. Theme 1 identified the 'Knowledge and beliefs' influencing participants intentions to facilitate normal physiological birth, including 'Definitions and nomenclature', 'Knowledge acquisition', and 'Communication and litigation'. Theme 2 identified 'External influences' impacting participants intentions to facilitate normal physiological birth and included 'Colleagues', 'Structures - policy, resources and models of care', and 'Women and the Community'.

While obstetricians aimed to support the enabling of normal physiological birth, their intentions were influenced by many factors. Facilitating interdisciplinary interactions and education, embedding woman-centred care and promoting midwives' autonomy and full scope of practice would further alleviate known barriers.