(1164) The Impact of an Independent, Academic Midwifery Practice on Labor and Delivery Unit Culture

Single center, longitudinal prospective cohort study of L&D providers following a natural “intervention” consisting of the addition of an independent, academic, midwifery-only practice group (not supervised by Obstetricians) to the traditional University hospital physician-led L&D unit. The Labor Culture Survey (VanGompel et al. 2018) was administered to L&D providers longitudinally at baseline (May 2020), 1 year (June 2021), and 2 years (June 2022) after this “intervention” (referred to as epochs 1, 2 and 3). Surveys were completed voluntarily, electronically via RedCap and scored on a Likert-type scale (5: strongly agree; 1: strongly disagree). The primary outcome, difference in mean score over time, was analyzed using one-way ANOVA and Tukey’s post-hoc test for significance. Cesarean birth rates pre- and post-intervention were compared as a secondary outcome.

Results: 91 total surveys were completed (response rate: 37%). Respondents were majority female physicians (91.2%) aged 39.3±0.5 years. Following the “intervention”, physicians were more likely to welcome doulas as members of the labor support team (p=0.017), support more doula services (p=0.013), and more midwifery services (p=0.042) (Figure 1) as strategies to reduce Cesarean birth rates. Simultaneously, the University hospital saw a decrease in the total Cesarean birth rate from 37.5% in 2019 to 31.9% in 2021 (p< 0.001).

Conclusion:

Midwifery-style L&D care is known to promote and support physiologic birth in uncomplicated pregnancies. Changing L&D culture and subjective norms via the addition of a midwifery-only practice to a traditional L&D unit has the potential for meaningful changes in perceptions, actions, and behaviors by physician providers.