Relationship between obstetricians' cognitive and affective traits and delivery outcomes among women with a prior cesarean.

Abstract

We sought to investigate the relationship between obstetricians' cognitive traits and delivery outcomes among women with a prior cesarean delivery. A total of 94 obstetricians completed 5 standardized psychometric scales: Reflective Coping, Proactive Coping, Multiple Stimulus Types Ambiguity Tolerance (MSTAT), Need for Cognition, and State-Trait Anxiety Inventory. Scores were analyzed by quartile. Delivery data were collected for primiparas with 1 prior low transverse cesarean delivery and a term, cephalic singleton. We used χ(2) tests and random effects logistic regression to examine the relationship between obstetricians' cognitive traits and their patients' frequency of trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC). Of 1502 eligible patients, 22.6% underwent TOLAC. Women were more likely to undergo TOLAC when cared for by physicians with scores in the highest quartile of the proactive coping (33.6% vs 19.6%; P < .001), MSTAT (29.2% vs 21.0%; P = .002), and Need for Cognition (27.9% vs 21.5%; P = .02) assessments, or in the lowest quartile for anxiety assessment (28.0% vs 20.6%; P = .001). Similarly, those with high proactive coping (18.0% vs 11.3%; P = .001), high MSTAT (16.6% vs 11.8%; P = .03), and low anxiety (19.2% vs 10.4%; P < .001) had greater VBAC rates. Random effects regression analyses revealed physicians with high proactive coping remained significantly more likely to have patients undergo TOLAC (adjusted odds ratio, 1.86; 95% confidence interval, 1.10-3.14) and those with low anxiety remained significantly more likely to have patients experience VBAC (adjusted odds ratio, 2.08; 95% confidence interval, 1.28-3.37). There is an increased likelihood of TOLAC and VBAC for women delivered by physicians with more proactive coping and less anxiety.