New, improved KALI questionnaire

Here is the new, improved KALI (Knowledge and Attitudes of Labor Interventions) questionnaire. Thanks for all the input. I think everyone who gave suggestions will see them reflected in the questions.

I included the demographics this time. I struggled a lot with this section, and still have a lot of guilt. I want to say I feel like I am part of the problem currently, since “gender” is a binary in my study. I wanted to include “transsexual” and “intersexed” or even “other” and a blank as an option, but my mentors nixed it. They say this is not the purpose of the study, and isn’t relevant to my study population. I have no idea if there are no ob/gyns in the tri-county area who don’t strictly identify as “male” or “female”, but I guess they are assuming there aren’t any. I caved. I did hold out for allowing people to pick more than one race. Geez.


The KALI Project Survey

Thank you for agreeing to participate in the Knowledge and Attitudes of Labor Interventions (KALI) survey. This survey is intended to gather information about obstetrical practice patterns. The survey is anonymous, and should take about fifteen minutes. By completing this survey, you are giving consent to be part of this study.

First, we would like to gather some information about you and your practice. Please answer these questions by either circling your answers or writing your answers in blanks provided. This information will be kept confidential.

1. What is your gender?
Male       Female

2. Age:
20 – 29      60 – 69
30 – 39      70 – 79
40 – 49      80 – 89
50 – 59      90 or older

3. Do you have children?
Yes       No

4. Race (choose as many as apply):
White / Caucasian          Native Hawaiian / Pacific Islander
African American / Black         Native American Indian /Alaskan Native
Asian or Asian American           Other:________

5. Ethnicity:
Hispanic or Latino
Neither Hispanic nor Haitian

6. How would you describe the location of your ob/gyn residency?
University affiliated
Other: ________________

7. Year of residency completion ______

8. Which of the following most accurately describes your practice type?
Public hospital
Community health center
University based practice
Private practice
If private –
Large partnership (four or more partners)
Small partnership (two or three partners)
Solo practice
Military / government

9. Do you currently practice obstetrics?
If yes:
Average clinical time spent with prenatal clients:______________(%)
Average number of deliveries per year:________________

10. Which of the following most accurately describes your personal practice scope?
General obstetrics and gynecology
General gynecology only
Obstetrics only
Maternal Fetal Medicine
Reproductive Endocrinologist
Gynecologic Oncology
Other: ______________________________

11. Which of the following most accurately describes your current malpractice coverage?
_____None / I “go bare”
_____I pay for individual malpractice insurance
_____My practice pays my malpractice premiums
_____I am an employee of an institution that pays my malpractice premiums
_____I am an employee of an organization or institution that provides legal defense but
not malpractice insurance
Other: ___________________

Please rate the following statements about obstetrics as accurately as possible. All questions will have this scale available for you. Please choose whether you:

1. Strongly agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree

1. _____Restricting maternal intake of all nutrition by mouth during labor prevents serious adverse maternal outcomes.

2. _____Elective cesarean section should not be performed on a woman desiring several children.

3. _____Doulas (i.e. private labor coaches, or trained labor companions) improve maternal and newborn outcomes.

4. _____Episiotomy should be avoided if at all possible.

5. _____The use of continuous external fetal monitoring (EFM) increases the risk for cesarean delivery.

6. _____In the absence of maternal and fetal medical indications, vaginal deliveries confer more risk than cesarean deliveries.

7. _____Insurance should not reimburse use of doulas for labor and delivery.

8. _____I employ episiotomy routinely, because it is easier to repair than lacerations that result when an episiotomy is not used.

9. _____Fear of liability claims limit the options I present to my obstetrical patients.

10. _____Liability insurance company policies forbid me from performing VBACs.

11. _____Use of upright (non lithotomy) positions during the pushing and birth has no positive impact on perinatal outcomes.

12. _____The use of continuous EFM does not result in a reduction of cerebral palsy.

13. _____All women in early active labor should have an amniotomy (i.e. artificial rupture of membranes or AROM ) if they present with their membranes intact.

14. _____Few women would choose to have a vaginal birth after cesarean (VBAC) if they knew the consequences of uterine rupture.

15. _____I regularly employ episiotomy to shorten the second stage of labor and delivery.

16. _____Low risk labor patients should be offered the option of intermittent fetal heart rate monitoring in labor.

17. _____Elective cesarean section should only be performed after accurately determining 39 weeks of gestation.

18. _____Mediolateral episiotomies result in less postpartum pain than median episiotomies.

19. _____The hospitals in which I attend births do not have sufficient staff to support intermittent fetal heart rate monitoring during labor.

20. _____Most patients attempting vaginal delivery benefit from oxytocin (Pitocin) augmentation of their labor.

21. _____I regularly employ episiotomy to prevent pelvic floor relaxation.

22. _____Hospital policies forbid me from performing VBACs.

23. _____If my partner or I were pregnant for the first time, I would recommend an elective cesarean delivery in the absence of any medical or obstetrical indication.

24. _____I have made changes to my practice because of the risk or fear of liability claims.

25. _____Childbirth is only normal in retrospect.

26. _____Clinical guidelines are useful tools for me in daily clinical practice.

27. _____I regularly employ episiotomy to prevent perineal trauma.

28. _____The use of continuous EFM reduces perinatal mortality.

29. _____I encourage my patients to try alternative or upright positions during the pushing stage.

30. _____Physicians should initiate discussion of elective cesarean delivery as part of routine prenatal care.

31. _____I refer patients who want to attempt a trial of labor after a prior cesarean delivery to another practitioner.

32. _____Women should have the right to refuse an episiotomy.

33. _____I recommend that most patients use a doula for their labor and delivery.

34. _____I feel that it is a woman’s right to elect to have a caesarean section even if there are no clear maternal or fetal indications.

35. _____There is high interobserver and intraobserver variability in interpretation of fetal heart rate tracing.

36. _____Hospital standards of care or policies sometimes get in the way of optimal management of individual patients.

37. _____I discuss the risks and benefits of episiotomies with my patients prior to delivery.

38. _____Routine artificial rupture of membranes (AROM) increases the risk of cesarean delivery.

39. _____If a patient asks if she could use a doula for her delivery, I would encourage her.

40. _____Most women with one previous cesarean delivery with a low-transverse incision should be counseled about VBAC and offered a trial of labor.

41. _____Episiotomies increase the risk of third and fourth degree tears.

42. _____Clinical guidelines are overly rigid and difficult to adapt to individual patients.

How often do you consult the following sources regarding obstetrical practice?

1= Never 2= Rarely 3 = Sometimes 4 = Often 5 = Always

1. _____ACOG Practice Bulletins
2. _____ACOG Committee Opinions
3. _____Obstetrics and Gynecology Journals (e.g. the Green Journal, the Grey Journal)
4. _____Cochrane Database
5. _____PubMed/MEDLINE
6. _____Electronic evidence-based services (e.g. Epocrates, UptoDate)
7. _____Books and/or textbooks
8. _____Professional conferences
9. _____Physicians in my practice
10. _____Physicians in my local community
11. _____Physicians I trained with in residency
12. _____Physicians I consider experts in the field
Other sources: ____________________________

Have you ever been the subject of a professional liability claim or litigation?
If yes – Did the liability claim involve an obstetrical claim? Yes No

Thank you for your time and participation!

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6 responses to “New, improved KALI questionnaire

  1. Looks good. Any updated word from your IRB folks yet?

  2. Pingback: Highlights of the Lamaze Conference « Mom’s Tinfoil Hat

  3. I couldn’t find an email address to send this to you directly, but read this article and it reminded me of your survey.

    It sounds like she already had a VBAC with her 3rd child, so I don’t understand why the hospital is being so insistent she not deliver vaginally again. What a shitty system.

    • MomTFH

      Thanks! Yes, I heard about that case.

      I am not tech savvy enough to know why my About and Contact me pages are not available.

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