title: Do maternity care provider groups have different attitudes towards birth?
abstract: OBJECTIVE
  To compare family physicians', obstetricians' and midwives' self-reported practices, attitudes and beliefs about central issues in childbirth.
  
  
  METHODS
  Mail-out questionnaire. SETTING/POPULATION; All registered midwives in the province, and a sample of family physicians and obstetricians in a maternity care teaching hospital. Response rates: 91% (n = 50), 69% (n = 97) and 89% (n = 34), respectively.
  
  
  METHODS
  A postal survey.
  
  
  METHODS
  Twenty-three five-point Likert scale items (strongly agree to strongly disagree) addressing attitudes toward routine electronic fetal monitoring, induction of labour, epidural analgesia, episiotomy, doulas, vaginal birth after caesarean section (VBACs), birth centres, provision educational material, birth plans and caesarean section.
  
  
  RESULTS
  Cluster analysis identified three distinct clusters based on similar response to the questions. The 'MW' cluster consisted of 100% of midwives and 26% of the family physicians. The 'OB' cluster was composed of 79% of the obstetricians and 16% of the family physicians. The 'FP' cluster was composed of 58% the family physicians and 21% the obstetricians. Members of the 'OB' cluster more strongly believed that women had the right to request a caesarean section without maternal/fetal indications (P < 0.001), that epidurals early in labour were not associated with development of fetal malpositions (P < 0.001) and that increasing caesarean rates were a sign of improvement in obstetrics (P < 0.001). The 'OB' cluster members were more likely to say they would induce women as soon as possible after 41 3/7 weeks of gestation (P < 0.001) and were least likely to encourage the use of birth plans (P < 0.001). The 'MW' cluster's views were the opposite of the 'OBs' while the 'FP' cluster's views fell between the 'MW' and 'OB' clusters.
  
  
  CONCLUSIONS
  In our environment, obstetricians were the most attached to technology and interventions including caesarean section and inductions, midwives the least, while family physicians fell in the middle. While generalisations can be problematic, obstetricians and midwives generally follow a defined and different approach to maternity care. Family physicians are heterogeneous, sometimes practising more like midwives and sometimes more like obstetricians.
authors.affiliation: Faculty of Nursing, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Birgit
authors.initials: B
authors.lastname: Reime
authors.forename: Michael C
authors.initials: MC
authors.lastname: Klein
authors.forename: Ann
authors.initials: A
authors.lastname: Kelly
authors.forename: Nancy
authors.initials: N
authors.lastname: Duxbury
authors.forename: Lee
authors.initials: L
authors.lastname: Saxell
authors.forename: Robert
authors.initials: R
authors.lastname: Liston
authors.forename: Frédérique Josephine Petra Maria
authors.initials: FJ
authors.lastname: Prompers
authors.forename: Robert Stefan Willem
authors.initials: RS
authors.lastname: Entjes
authors.forename: Victor
authors.initials: V
authors.lastname: Wong
mesh_terms: D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D036861:Delivery, Obstetric / Q000523:psychology*; D004841:Episiotomy; D005260:Female; D005323:Fetal Monitoring; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007751:Labor, Induced; D008297:Male; D009721:Nurse Midwives / Q000523:psychology*; D009774:Obstetrics; D010821:Physicians, Family / Q000523:psychology*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D016064:Vaginal Birth after Cesarean