Attitudes and Perceptions of Healthcare Providers Regarding the Safe Reduction of the Cesarean Section [7C

Abstract

INTRODUCTION: The American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) identified risk factors that increase the likelihood for a cesarean section (C/S). Analysis of these factors can aid in the safe reduction of the C/S rate within an institution. METHODS: Surveys comprised of clinical scenarios regarding the ACOG/SMFM C/S risk factors were sent to all providers within a hospital system. 250 surveys were analyzed using profession, experience, multiple hospital system exposure, and malpractice influence as outcome variables. Analysis was performed using Pearson correlation, Student's T-test, Chi-square Analysis, and Levene’s test. RESULTS: Baseline results showed that most C/S are done for category 2 fetal heart rate, about 40% of providers practice defensively, and that more providers are willing to speak up to a nurse, as compared to an attending. Significant findings showed that providers with a previous lawsuit are more likely to practice defensively (66.4% vs 47.8%, P-.002) and to speak up when they disagree with a care plan (80% vs 63%, P-.002). Nurses, as opposed to physicians, are more willing to wait during labor rather than support a C/S (91.6% vs 70%, P-.000), but are less likely to speak up (64.1% vs 79.6%, P-.006). More experienced providers are more likely to speak up (85.3% vs 57%, P-.000) and less likely to induce at 41 weeks (19.9% vs 31.5%, P-.021). CONCLUSION: These results suggest local risk factors that may be associated with increased C/S rates; this knowledge can be utilized to develop appropriate interventions to safely reduce the C/S rate.