Midwives' personal and professional attitudes towards women's delivery choices, interventions and neonatal care.

Abstract

Caesarean section (CS) rates in middle- and high-income countries are rising partly due to maternal request. This study aimed to explore the personal and professional attitudes of midwives and nurses towards women's delivery choices, interventions and neonatal care. Midwifery and nursing staff at the Coombe hospital were asked to complete a questionnaire concerning decisions for elective CS and neonatal care. The midwives' responses were divided into multiparous and nulliparous according to their own parity. Multiparae and nulliparae did not differ on their personal preferences for their own baby. Only 3% wanted an elective CS in a normal, healthy pregnancy but this increased to 80.2% when there was a breech presentation and 42% if the estimated fetal weight was >4.5kg. These numbers and trends were very close to the midwives' professional recommendations under the same circumstances. The lower threshold for full resuscitation and ICU care was at 23 and 24weeks gestation for both personal and professional recommendations. In the case of severely premature babies or babies with a poor prognosis, 54% stated that the approach to neonatal care was correct. Overall, midwives' professional views reflected what they would want for themselves and their babies. Only 3% recommended an elective CS in a normal, healthy pregnancy making it unlikely that midwives' attitudes are driving the rise in CS rates in Ireland.