Certified Nurse Midwife (CNM) Attitudes about Birth and Primary Cesarean Section Rates - Abstract
In this small retrospective cohort study we analyzed birth data from the International Center for Maternity’s [CIMA] database 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 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 used a focus group of five midwives. The survey had a total of 13 points possible; a low score indicates commitment to the medical model of birth. We used simple linear regression to investigate each of the survey questions and the total score 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 results suggested an inverse relationship between the survey’s holistic score and primary cesarean section rates. Using the total score as the independent variable, the model yielded an r2 of .45. Our results indicate that CIMA’s midwives identify more with the holistic model of birth and that this algorithm could statistically 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 might predict primary cesarean section rates.