Cesarean delivery on maternal request: obstetrician-gynecologists' knowledge, perception, and practice patterns.

OBJECTIVE: To examine obstetrician-gynecologists' knowledge, opinions, and practice patterns related to cesarean delivery on maternal request. METHODS: Questionnaires were mailed to 1,031 American College of Obstetricians and Gynecologists Fellows in February 2006, with a response rate of 68%. The questionnaire queried respondents' demographic characteristics, practices and attitudes surrounding vaginal and cesarean deliveries, knowledge and beliefs regarding the risks and benefits of elective and nonelective cesarean delivery, and counseling practices and department policies for cesarean delivery on maternal request. RESULTS: About half of respondents believe women have the right to cesarean delivery on maternal request, and a similar percentage acknowledge having performed at least one cesarean delivery on maternal request. Fifty-eight percent of respondents note an increase in patient inquiries regarding cesarean delivery over the past year, yet most of their practices do not have a policy regarding this procedure. Respondents attribute the increase in inquiries to the increase of information from the media and to convenience. Respondents cited more risks than benefits of cesarean delivery on maternal request, and nearly all discuss these risks with patients who are considering one. Females were more negative toward cesarean delivery on maternal request than males and endorsed more risks and fewer benefits. There were no relationships between assessment of risks and benefits or practice with clinician age or patient characteristics. CONCLUSION: Most obstetrician-gynecologists in this study recognized an increased demand for cesarean delivery on maternal request within their practices, while believing that the risks of this procedure outweigh the benefits. Clinicians would benefit from strong evidence regarding risks and benefits, evidence that is crucial to guiding policy making with regard to cesarean delivery on maternal request. LEVEL OF EVIDENCE: III.

Professional liability and other career pressures: impact on obstetrician-gynecologists' career satisfaction.

OBJECTIVE: To investigate the impact of career pressures on career satisfaction and satisfaction with job-specific activities among obstetrician-gynecologists. METHODS: A questionnaire was sent to 1,500 member-Fellows of The American College of Obstetricians and Gynecologists in June 2001. The analyses were designed to examine the relationship between career pressures in 3 domains on clinicians' professional satisfaction. RESULTS: Overall career satisfaction and satisfaction with job-specific activities were both inversely related to the perceived impact of career pressures. The major impact reported was that liability insurance costs would shorten the duration of the members' careers. Managed care had less impact than liability, with moderate concern surrounding the limitation of diagnostic and treatment options. Obstetrician-gynecologists were less satisfied with their careers and job-specific activities if they believed the cost or time of obtaining continuing medical education requirements to be a burden. CONCLUSION: Career pressures produced by liability insurance costs have more negative impact on clinicians' satisfaction with their professional lives and job-specific activities than managed care and requirements for continuing medical education.

Heavier workload, less personal control: Impact of delivery on obstetrician/gynecologists' career satisfaction.

OBJECTIVE: Obstetrician/gynecologists' career satisfaction with certain work-related activities was examined among clinicians who perform deliveries and clinicians who do not. STUDY DESIGN: A questionnaire was sent to 1500 member-fellows of the American College of Obstetricians and Gynecologists; 842 members (56%) responded. The questionnaire was designed to distinguish between obstetrician/gynecologists who perform deliveries and clinicians who do not in the areas of satisfaction with specific aspects of career and work-related activities. Data were examined initially by multivariate analysis of variance and subsequently by univariate analysis of variance if the multivariate test was found to be significant. RESULTS: Workload and personal control were the primary factors for which there was a significant difference in satisfaction between clinicians who perform deliveries and clinicians who do not (P<.001). Obstetrician/gynecologists who do not perform deliveries reported working significantly fewer hours per week (P<.001) and had more satisfaction with their work activities than the delivery group overall. Despite lowered satisfaction with certain career aspects among the delivery Group, the highest positive disposition ratings that was given by respondents were for surgery, vaginal delivery, and planned cesarean delivery, with gender differences observed in the level of disposition for these particular activities. The most negative rating was reported for on-call/in-hospital time. CONCLUSION: Although positive disposition is associated with the activity of vaginal and cesarean delivery overall, 2 primary contributing factors of dissatisfaction that were identified among obstetrician/gynecologists who perform deliveries were increased workload and decreased personal control.