Certified Nurse Midwife (CNM) Attitudes about Birth and Primary Cesarean Section Rates Open Access

Riley, Chelsea J. (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/xd07gt09k?locale=en


In this small retrospective cohort study we analyzed birth data from the International Center for Maternity's [CIMA] birth data from 2009-2015 (n=5,291) to evaluate if primary cesarean section rates are associated with midwives' attitudes towards the medical model of birth. CIMA is a midwife-led prenatal care, labor, and delivery practice that mainly serves Hispanic immigrants in the Atlanta, GA area. CIMA has a primary cesarean section rate of 13.7%; the national average is 21.5%. After developing survey questions, we conducted a focus group of 5 midwives to validate the questions. Two identified with the holistic model of birth and 3 identified with the medical model of birth. After validation, the survey was administered to CIMA's 11 midwives. There were a total 13 questions to evaluate support for holistic or medical model of birth in the final survey. The survey had a total of 13 points possible; a midwife who answered holistically to every question would have a score of 13. Simple linear regression was used to investigate each of the survey questions and the total score as the independent variable with primary cesarean section rates as the dependent variable. Scores ranged from 6.4-12.8 out of 13 possible points. The average score for CIMA's 11 midwives was 10.33 [95% CI: (8.82, 11.83)]. The mean primary cesarean section rate is 13.70 [95% CI: (11.93, 15.48)]. The results suggested an inverse relationship between the survey's holistic score and primary cesarean section rates. When the totaled score was used as the independent variable, the model yielded an r2 of .45. The linear regression model predicts a decrease of .79% in primary cesarean section rates for every 1-point increase on in a midwife's holistic midwife score. In conclusion, our results indicate that CIMA's midwives identify more with the holistic model of birth and that a holistic midwife scoring algorithm could predict, to some degree, a midwife's primary cesarean section rate. Our findings, taken in context with previous midwife studies, suggest that a survey detailing midwives attitudes towards the medical model of birth could be used to predict primary cesarean section rates.

Table of Contents

Chapter 1: Background 1

A brief History of Cesarean Sections 1

Modern Cesarean Sections 3

Cesarean Section Trends 4

Cesarean Sections: Medical and Holistic Models of Delivery 5

The History of Centro Internacional de Maternidad 6

Chapter 2: Manuscript 9

Introduction 10

Methods 11

Results and Conclusions 13

Discussion 17

References 19

Chapter 3: Public Health Implications 22

Appendix 23

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