This is the absolute last version of the KALI questionnaire. (You can access the previous incarnations here.)
How do I know this? Well, first of all, one of my mentors gave me the lifted eyebrow when I went to him to talk about the wording, again, on Monday. I am particular and a hair splitter, but I also had a good reason to change the wording of this part. I had a problem with it from the beginning, and one of my beta testers also had an issue with it. I was editing the second to last question, and it used to say “How often do you consult the following sources regarding obstetrical practice?” But, I really didn’t want to know how often the physicians literally consulted these sources. No physician furtively looks in a textbook “always” or “often”. I wanted to know how useful these sources were in clinical decision making, how valuable the physicians considered each source to be, and how often they applied the knowledge from these sources to their clinical practice. And, I wanted it to be in one question, since I had three complaints about the length of the survey by beta testers. (This version is also a few questions shorter, and one question is a combination of two previous ones.)
So, I ended up with: “This final section lists potential sources that you may consult to stay up to date on obstetrical standards of care. How often are the following sources useful in making clinical decisions?” Not perfect, but I am accepting it and moving on.
The second reason I know this is the final version, at least for this research, is because I sent out a few email invites yesterday. (Eep! Wish me a good response rate!) I will be phoning ob/gyn offices today, begging for email addresses for the physicians in the practice. (Eep! Wish me good luck getting email addresses!)
So, here is the final questionnaire:
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. You are:
____________ years old
3. Do you have children?
 Hispanic or Latino
 Neither Hispanic nor Haitian
5. Race (choose as many as apply):
 African American / Black  Native Hawaiian / Pacific Islander
 Asian or Asian American  White / Caucasian
 Native American Indian /Alaskan  Other:_______________________
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?
9a. Average time spent with prenatal clients:
 Less than 20%
 20% to less than 50%
 50% to less than 80%
 80% to 100%
9b. 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. Please choose whether you:
 Strongly disagree
 Neither agree nor disagree
 Strongly agree
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. _____I employ episiotomy routinely, because it is easier to repair than lacerations that
result when an episiotomy is not used.
8. _____Fear of liability claims limit the options I present to my obstetrical patients.
9. _____Liability insurance company policies forbid me from performing vaginal births after cesareans (VBACs).
10. _____Use of upright (non lithotomy) positions during the pushing and birth has no positive impact on perinatal outcomes.
11. _____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.
Strongly disagree Disagree Neither agree nor disagree Agree Strongly Agree
12. _____Few women would choose to have a vaginal birth after cesarean (VBAC) if they knew the consequences of uterine rupture.
13. _____I regularly employ episiotomy to shorten the second stage of labor and delivery.
14. _____Low risk labor patients should be offered the option of intermittent fetal heart rate monitoring in labor.
15. _____Elective cesarean section should only be performed after accurately determining 39 weeks of gestation.
16. _____Mediolateral episiotomies result in less postpartum pain than median episiotomies.
17. _____Prior to an induction, patients should be counseled about the possible need for reinduction or cesarean delivery.
18. _____The hospitals in which I attend births do not have sufficient staff to support intermittent fetal heart rate monitoring during labor.
19. _____Most patients attempting vaginal delivery benefit from oxytocin (Pitocin) augmentation of their labor.
20. _____I regularly employ episiotomy to prevent pelvic floor relaxation.
21. _____Hospital policies forbid me from performing VBACs.
22. _____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.
23. _____I have made changes to my practice because of the risk or fear of liability claims.
24. _____Childbirth is only normal in retrospect.
25. _____Clinical guidelines are useful tools for me in daily clinical practice.
26. _____The use of continuous EFM reduces perinatal mortality and morbidity.
Strongly disagree Disagree Neither agree nor disagree Agree Strongly Agree
27. _____Labor induction for non-medical indications (psychosocial or logistical) should only be attempted after establishing a gestational age of 39 weeks.
28. _____I encourage my patients to try alternative or upright positions during the pushing stage.
29. _____Physicians should initiate discussion of elective cesarean delivery as part of routine prenatal care.
30. _____I refer patients who want to attempt a trial of labor after a prior cesarean delivery to another practitioner.
31. _____Women should have the right to refuse an episiotomy.
32. _____I recommend that most patients use a doula for their labor and delivery.
33. _____Women should be able to have a caesarean section even if there are no clear maternal or fetal indications.
34. _____There is high interobserver and intraobserver variability in interpretation of fetal heart rate tracing.
35. _____Hospital standards of care or policies sometimes get in the way of optimal management of individual patients.
36. _____Routine artificial rupture of membranes (AROM) increases the risk of cesarean delivery.
37. _____I would refer out any patient who wants to hire a doula.
38. ¬¬_____Time and scheduling pressures affect the way I manage labor and delivery.
39. _____Most women with one previous cesarean delivery with a low-transverse incision should be counseled about VBAC and offered a trial of labor.
40. _____Episiotomies increase the risk of third and fourth degree tears.
41. _____Clinical guidelines are overly rigid and difficult to adapt to individual patients.
This final section lists potential sources that you may consult to stay up to date on obstetrical standards of care. How often are the following sources useful in making clinical decisions?
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. _____Electronic evidence-based services (e.g. Epocrates, UptoDate)
6. _____Books and/or textbooks
7. _____Professional conferences
8. _____Physicians in my practice
9. _____Physicians in my local community
10. _____Physicians I trained with in residency
11. _____Physicians I consider experts in the field
12. 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?
Thank you for your time and participation!