Abstract
The objective of the study was to investigate the relationship between physician coping skills, need for cognition, tolerance of ambiguity, and anxiety and their patients' mode of delivery. Ninety-four obstetricians were surveyed using 5 standardized psychometric scales: Reflective Coping, Proactive Coping, Multiple Stimulus Types Ambiguity Tolerance-II, Need for Cognition (measures learner motivation and engagement in cognitive efforts), and State-Trait Anxiety Inventory. Psychometric test scores were analyzed by quartile. Data regarding route of delivery were collected on 3488 nulliparous, term, cephalic, nonanomalous singleton deliveries performed by participating physicians. χ(2) tests and random-effects logistic regression analyses were used to examine the relationship between the obstetrician cognitive traits and type of delivery. Sixty-one percent of the women were delivered by spontaneous vaginal delivery, 15.5% by operative vaginal delivery, and 23.5% by cesarean delivery. Random-effects multivariable logistic regression adjusting for patient characteristics demonstrated that physicians with the most reflective coping (ie, highest quartile) were significantly less likely (adjusted odds ratio, 0.70; 95% confidence interval, 0.50-0.98) to perform operative vaginal delivery. However, lower anxiety and higher ambiguity tolerance were associated with an increased risk of chorioamnionitis and postpartum hemorrhage, respectively. There were no identified differences in adverse neonatal outcomes by physician cognitive or affective traits. There is a decreased risk of operative vaginal delivery for patients delivered by providers with better adaptive decision-making traits. Other cognitive and affective traits were associated with a greater chance of chorioamnionitis and hemorrhage. Further work is required to elucidate whether training in these cognitive and affective traits can alter obstetric outcomes.
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