This is the survey on labor interventions that will be my research project for my fellowship. Many of these are taken from other studies, position statements, practice bulletins, and meta-analysis conclusions. There is also a demographics and practice description portion of the questionnaire, which I did not include in this post. The target population will be practicing ob/gyns in a certain geographical area. Please let me know what you think.
Keep in mind that the question are supposed to be mixed to prevent bias based on how they ordered are in conjunction with other questions on the same topic, and they are mixed in positive and negative phrasing, and mixed in whether they are talking about practice, knowledge, attitudes or future intentions.
Here it is:
Please rate the following statements about obstetrics as accurately as possible. All questions will have this scale available for you to choose to most appropriate response:
1. Strongly agree
3. Neither agree nor 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. Use of upright (non lithotomy) positions during the pushing and birth has no positive impact on perinatal outcomes.
11. The use of continuous EFM does not result in a reduction of cerebral palsy.
12. All women in labor should have an amniotomy (i.e. artificial rupture of membranes or AROM ) if they present with their membranes intact.
13. Few women would choose to have a vaginal birth after cesarean (VBAC) if they knew the consequences of uterine rupture.
14. I regularly employ episiotomy to shorten the second stage of labor and delivery.
15. Low risk labor patients should be offered the option of intermittent fetal heart rate monitoring in labor.
16. Elective cesarean section should only be performed after accurately determining 39 weeks of gestation.
17. The hospitals in which I attend births do not have sufficient staff to support intermittent fetal heart rate monitoring during labor.
18. Most patients attempting vaginal delivery benefit from oxytocin (Pitocin) augmentation of their labor.
19. I regularly employ episiotomy to prevent pelvic floor relaxation.
20. If you or your partner were pregnant for the first time, would you choose / recommend an elective cesarean delivery for yourself or your partner in the absence of any medical or obstetrical indication?
21. I have made changes to my practice because of the risk or fear of liability claims.
22. Childbirth is only normal in retrospect.
23. I regularly employ episiotomy to prevent perineal trauma.
24. The use of continuous EFM reduces perinatal mortality.
25. I encourage my patients to try alternative or upright positions during the pushing stage.
26. Physicians should initiate discussion of elective cesarean delivery as part of routine prenatal care.
27. I refer patients who want to attempt a trial of labor after a prior cesarean delivery to another practitioner.
28. Women should have the right to refuse an episiotomy.
29. I encourage patients to use a doula for their labor and delivery.
30. 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.
31. There is high interobserver and intraobserver variability in interpretation of fetal heart rate tracing.
32. Hospital standards of care or policies sometimes get in the way of optimal management of individual patients.
33. I discuss the risks and benefits of episiotomies with my patients prior to delivery.
34. Routine artificial rupture of membranes (AROM) increases the risk of cesarean delivery.
35. Most women with one previous cesarean delivery with a low-transverse incision should be counseled about VBAC and offered a trial of labor.
36. Episiotomies increase the risk of third and fourth degree tears.
37. Clinical guidelines are useful tools for me in daily clinical practice.
38. 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. 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 ____________________________