ArticleHealth services research2019
Cesarean overuse and the culture of care.
Article in Health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
What it found
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The trial behind it
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Who cites it
26 citing papers in PubMed.
- Temporal-spatial trends in childbirth in Ontario, Canada.PloS one · 2026Article
- Employee Net Promoter Score Links Nursing Satisfaction to Quality of Care Before and During the COVID-19 Pandemic.Journal of nursing management · 2026Article
- Racial and Ethnic Disparities in Cesarean Birth Trends in the United States.JAMA network open · 2025Observational
- Health system drivers of caesarean deliveries in south Asia: a scoping review.The Lancet regional health. Southeast Asia · 2025Review
- Work Experience and Attitudes About Birth in Relation to Nurses' Cesarean Rates for Women With Low-Risk Pregnancies.Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2025Article
- "It's a priority": a qualitative analysis of the implementation of a maternal equity safety bundle in Massachusetts.Implementation science communications · 2025Article
- Creating effective teams and valuing patient-centered care to change culture and improve equity on labor and delivery: a qualitative study.BMC health services research · 2024Article
- Evaluation of Statewide Program to Reduce Cesarean Deliveries Among Nulliparous Individuals With Singleton Pregnancies at Term Gestation in Vertex Presentation.Obstetrics and gynecology · 2024Article
- Variations in the use of oxytocin for augmentation of labour in Sweden: a population-based cohort study.Scientific reports · 2024Article
- Shared Decision Making in Perinatal Care.Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2024Article
- An alternative model of maternity care for low-risk birth: Maternal and neonatal outcomes utilizing the midwifery-based birth center model.Health services research · 2024Observational
- Academic education of midwives in Germany (part 2): Opportunities and challenges for the further development of the profession of midwifery. Position paper of the Midwifery Science Committee (AHW) in the DACH Association for Medical Education (GMA).GMS journal for medical education · 2024Article
- Disentangling Safety Culture's Role in Reducing Cesarean Overuse: Creating a Revised Labor Culture Survey.Women's health reports (New Rochelle, N.Y.) · 2024Article
- Hospital-level variation in racial disparities in low-risk nulliparous cesarean delivery rates.American journal of obstetrics & gynecology MFM · 2023Article
- 'Do we need doulas…?' - Perspectives of maternity care managers on the role of doulas in Poland.Nursing open · 2023Article
- Attitudes of Clinicians and Patient Safety Culture Before and After the ARRIVE Trial.Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2023Article
- Latent phase duration and associated outcomes: a contemporary, population-based observational study.American journal of obstetrics and gynecology · 2023Observational
- The effect of organizational belonging and profession on clinicians' attitudes toward supporting vaginal birth and interprofessional teamwork-a cross-sectional study.Acta obstetricia et gynecologica Scandinavica · 2023Article
- Implementation strategies within a complex environment: A qualitative study of a shared decision-making intervention during childbirth.Birth (Berkeley, Calif.) · 2022Article
- Clinicians' views of factors influencing decision-making for CS for first-time mothers-A qualitative descriptive study.PloS one · 2022Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectiveTo assess hospital unit culture and clinician attitudes associated with varying rates of primary cesarean delivery. DATA SOURCES/STUDY
settingIntrapartum nurses, midwives, and physicians recruited from 79 hospitals in California participating in efforts to reduce cesarean overuse. STUDY
designLabor unit culture and clinician attitudes measured using a survey were linked to the California Maternal Data Center for birth outcomes and hospital covariates.
methodsAssociation with primary cesarean delivery rates was assessed using multivariate Poisson regression adjusted for hospital covariates. PRINCIPAL
findings1718 respondents from 70 hospitals responded to the Labor Culture Survey. The "Unit Microculture" subscale was strongly associated with primary cesarean rate; the higher a unit scored on 8-items describing a culture supportive of vaginal birth (eg, nurses are encouraged to spend time in rooms with patients, and doulas are welcomed), the cesarean rate decreased by 41 percent (95% CI = -47 to -35 percent, P < 0.001). Discordant attitudes between nurses and physicians were associated with increased cesarean rates.
conclusionsHospital unit culture, clinician attitudes, and consistency between professions are strongly associated with primary cesarean rates. Improvement efforts to reduce cesarean overuse must address culture of care as a key part of the change process.
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Registered trials
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