Family physicians who provide intrapartum care and those who do not: very different ways of viewing childbirth

Abstract

Objective: To examine FPs' attitudes toward birth for those providing intrapartum care (IPC) and those providing only antepartum care (APC).

Design: National, cross-sectional Web- and paper-based survey.

Setting: Canada.

Participants: A total of 897 Canadian FPs: 503 providing both IPC and APC (FPIs), 252 providing only APC but who previously provided IPC (FPPs), and 142 providing only APC who never provided IPC (FPNs).

Main outcome measures: Respondents' views (measured on a 5-point Likert scale) on routine electronic fetal monitoring, epidural analgesia, routine episiotomy, doulas, pelvic floor benefits of cesarean section, approaches to reducing cesarean section rates, maternal choice and the mother's role in her own child's birth, care providers' fears of vaginal birth for themselves or their partners, and safety by mode or place of birth.

Results: Results showed that FPIs and FPPs were more likely than FPNs were to take additional training or advanced life support courses. The FPIs consistently demonstrated more positive attitudes toward vaginal birth than did the other 2 groups. The FPPs and FPNs showed significantly more agreement with use of routine electronic fetal monitoring and routine epidural analgesia (P < .001). The FPIs displayed significantly more acceptance of doulas (P < .001) and more disagreement with the pelvic floor benefits of cesarean section than other FPs did (P < .001). The FPIs were significantly less fearful of vaginal birth for themselves or their partners than were FPPs and FPNs (P < .001). All FP groups agreed on rejection of elective cesarean section, in the absence of indications, for themselves or their partners and on support for vaginal birth in the presence of uterine scar. While all FP groups supported licensed midwifery, three-quarters thought home birth was more dangerous than hospital birth and showed ambivalence toward birth plans. Only 7.8% of FPIs would choose obstetricians for their own or their partners' maternity care.

Conclusion: The FPIs had a more positive, evidence-based view of birth. It is likely that FPs providing only APC are influencing women in their practices toward a relatively negative view of birth before referral to obstetricians, FPIs, or midwives for the actual birth. The relatively negative views of birth held by FPs providing only APC need to be addressed in family practice education and in continuing education.

Figure 1

Proportions of agreement with selected survey items: There was a lack of consensus among family practitioner groups regarding these interventions. EFM–electronic fetal monitoring, FPI–family physicians providing intrapartum and antenatal care, FPN–family physicians providing antenatal care who have never provided intrapartum care, FPP–family physicians providing antenatal care who previously provided intrapartum care. *Significant at or above α = .001. ^†Significant at or above α = .01. ^‡Significant at or above α = .05.

Figure 2

Proportions of agreement with selected survey items: There was a lack of consensus among family practitioner groups regarding these conceptual issues. FPI–family physicians providing intrapartum and antenatal care, FPN–family physicians providing antenatal care who have never provided intrapartum care, FPP–family physicians providing antenatal care who previously provided intrapartum care. *Significant at or above α = .001. ^†Significant at or above α = .05.

Figure 3

Selected areas of consensus among family physicians: For all itemsα > .05.