Attitudes of the New Generation of Canadian Obstetricians: How Do They Differ from Their Predecessors?

Authors

  • Michael C. Klein MD, FCFP, FAAP,

    1. Michael C. Klein is Senior Scientist Emeritus, Nazli Baradaran is Research Assistant, Stephen J.C. Hearps is Research Scientist, Jocelyn Tomkinson is Project Manager, Janusz Kaczorowski is Director, Primary Care & Community Research, and Rollin Brant is Centre Statistician, all in the Centre for Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia; Robert Liston is Professor and Head of the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia; and William D. Fraser is Professor and Chair of the Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
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  • Robert Liston MB, ChB, FRCSC, FRCOG,

    1. Michael C. Klein is Senior Scientist Emeritus, Nazli Baradaran is Research Assistant, Stephen J.C. Hearps is Research Scientist, Jocelyn Tomkinson is Project Manager, Janusz Kaczorowski is Director, Primary Care & Community Research, and Rollin Brant is Centre Statistician, all in the Centre for Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia; Robert Liston is Professor and Head of the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia; and William D. Fraser is Professor and Chair of the Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
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  • William D. Fraser MD, MSc, FRCPC,

    1. Michael C. Klein is Senior Scientist Emeritus, Nazli Baradaran is Research Assistant, Stephen J.C. Hearps is Research Scientist, Jocelyn Tomkinson is Project Manager, Janusz Kaczorowski is Director, Primary Care & Community Research, and Rollin Brant is Centre Statistician, all in the Centre for Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia; Robert Liston is Professor and Head of the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia; and William D. Fraser is Professor and Chair of the Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
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  • Nazli Baradaran MD,

    1. Michael C. Klein is Senior Scientist Emeritus, Nazli Baradaran is Research Assistant, Stephen J.C. Hearps is Research Scientist, Jocelyn Tomkinson is Project Manager, Janusz Kaczorowski is Director, Primary Care & Community Research, and Rollin Brant is Centre Statistician, all in the Centre for Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia; Robert Liston is Professor and Head of the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia; and William D. Fraser is Professor and Chair of the Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
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  • Stephen J. C. Hearps BPsyc, PGDipPsyc,

    1. Michael C. Klein is Senior Scientist Emeritus, Nazli Baradaran is Research Assistant, Stephen J.C. Hearps is Research Scientist, Jocelyn Tomkinson is Project Manager, Janusz Kaczorowski is Director, Primary Care & Community Research, and Rollin Brant is Centre Statistician, all in the Centre for Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia; Robert Liston is Professor and Head of the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia; and William D. Fraser is Professor and Chair of the Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
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  • Jocelyn Tomkinson BSc,

    1. Michael C. Klein is Senior Scientist Emeritus, Nazli Baradaran is Research Assistant, Stephen J.C. Hearps is Research Scientist, Jocelyn Tomkinson is Project Manager, Janusz Kaczorowski is Director, Primary Care & Community Research, and Rollin Brant is Centre Statistician, all in the Centre for Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia; Robert Liston is Professor and Head of the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia; and William D. Fraser is Professor and Chair of the Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
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  • Janusz Kaczorowski PhD,

    1. Michael C. Klein is Senior Scientist Emeritus, Nazli Baradaran is Research Assistant, Stephen J.C. Hearps is Research Scientist, Jocelyn Tomkinson is Project Manager, Janusz Kaczorowski is Director, Primary Care & Community Research, and Rollin Brant is Centre Statistician, all in the Centre for Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia; Robert Liston is Professor and Head of the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia; and William D. Fraser is Professor and Chair of the Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
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  • Rollin Brant PhD,

    1. Michael C. Klein is Senior Scientist Emeritus, Nazli Baradaran is Research Assistant, Stephen J.C. Hearps is Research Scientist, Jocelyn Tomkinson is Project Manager, Janusz Kaczorowski is Director, Primary Care & Community Research, and Rollin Brant is Centre Statistician, all in the Centre for Developmental Neuroscience and Child Health, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia; Robert Liston is Professor and Head of the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia; and William D. Fraser is Professor and Chair of the Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
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  • The Maternity Care Research Group


Address correspondence to Michael C. Klein, MD, CFPC, FCFP, FAAP, Emeritus Professor of Family Practice and Pediatrics, University of British Columbia & Children’s and Women’s Health Centre of British Columbia, Room L408—4500 Oak Street, Vancouver, BC, Canada V6H 3V4.

Abstract:

Background:  Attitudes drive practice, perhaps more than evidence. The objective of this study was to determine if the new generation of Canadian obstetricians has attitudes differing from those of their predecessors.

Methods:  Employing a cross-sectional, Internet, and paper-based survey, we conducted an in-depth study of obstetricians responding to the Canadian National Maternity Care Attitudes Survey.

Results:  Of the 800 Canadian obstetricians providing intrapartum care, 549 (68.6%) responded. Participants were stratified by age less than or equal to 40 years compared with those over 40 years; 81 percent of those 40 years or younger were women versus 40 percent over 40 years of age. Younger obstetricians were significantly more likely to favor use of routine epidural analgesia and believed that it did not interfere with labor or lead to instrumentation; were more concerned and feared the perineal and pelvic floor consequences of vaginal birth compared with cesarean section; and were significantly less supportive of vaginal birth after prior cesarean section, home birth, birth plans, routine episiotomy, and routine electronic fetal monitoring as providing maternal or fetal benefits. They were less positive than the older generation about a range of approaches to reducing the cesarean section rate, the importance of maternal choice and role in their own birth, and peer review, and they were more likely to believe that women having a cesarean section were not missing an important experience. No significant generational differences were found for ambivalent attitudes to vaginal breech birth.

Conclusions:  Younger obstetricians were more evidence-based for some issues and less for others. In general younger obstetricians were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, and they were less appreciative of the role of women in their own birth. They saw cesarean section as a solution to many perceived labor and birth problems. Results suggest a need to examine how obstetricians acquire their favorable attitudes to birth technology in normal birth. (BIRTH 38:2 June 2011)

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