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Factors Associated with Differences in Canadian Perinatal Nurses’ Attitudes Toward Birth Practices


  • The authors report no conflict of interest or relevant financial relationships.


Sarah J. Liva, MSN, RN, University of British Columbia, T201 2211 School of Nursing, Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada.



To test whether demographic characteristics predict registered nurses’ attitudes toward birth practices.


A secondary analysis of a cross-sectional survey, the National Maternity Care Attitudes Survey.


A national survey conducted with health care providers providing maternity care in Canada.


A convenience sample of 545 registered nurses.


Hierarchical regression analysis was used to examine three hypotheses about nurses’ demographic differences in relationship to their attitudes toward birth practices. Attitude scales included acceptability of doulas, effects of routine electronic fetal monitoring, factors decreasing cesarean birth rates, the importance of vaginal birth for women, safety of birth, episiotomy, and epidural analgesia.


Tertiary hospital–level of employment was associated with more positive attitudes toward epidural analgesia and less positive attitudes toward the importance of vaginal birth. Nurses working at a tertiary hospital were more likely to select an obstetrician for their own maternity care. Those who worked at a community hospital were more likely to select a family physician. Nurses’ selection of an obstetrician was associated with less positive attitudes toward the safety of birth and importance of vaginal birth and more positive attitudes toward electronic fetal monitoring, episiotomy, and epidural analgesia.


Nurses’ attitudes may be influenced by exposure in their workplaces to predominant care providers’ birth practices. Research examining the relationships between nurses’ workplace exposures, attitudes, and practice behaviors is needed to develop understanding about how nurses contribute to rates of intervention in maternity care.