Knowledge, attitudes, and practices of obstetrics residents towards cesarean delivery–sparing procedures

Objectives: Obstetrics and gynecology (ObGyn) trainees will impact future practice patterns and their cesarean rates. The knowledge, attitudes, and practices (KAP) of ObGyn residents have not been extensively studied. We aimed to assess KAP towards mode of delivery and cesarean-sparing procedures among ObGyn trainees. Methods: This is a multicountry study that was conducted in Brazil, Egypt, Ghana, Sweden, Thailand, Uganda, and the United States. A questionnaire was developed, piloted, translated, and adapted for ObGyn trainees in seven countries. The questionnaire was administered to assess knowledge regarding safety of cesarean and vaginal delivery (VD), attitudes towards mode of delivery, and perceived competency in performing cesarean-sparing procedures (forceps and vacuum-assisted VD, external cephalic version [ECV], and breech VD). The outcomes included the KAP of a group of global trainees, including number of procedures towards cesarean sections and cesarean-sparing procedures. Results: Of 744 complete responses, most residents perceive VD as safer than cesarean delivery for the mother (67%) and baby (55%). More trainees in Sweden (92%) and the United States (73%) agree that patients with breech presentation should be offered an ECV, compared with Ghana (8%), Egypt (8%), and Uganda (10%), and only in Sweden do most trainees feel competent with ECV (62%). Trainees in Ghana (86%) and Uganda (78%) report perceived competency with singleton breech VD while few do in Sweden (7%), Thailand (5%), and the United States (2%). Conclusion: Most trainees agreed on the comparative risks of CD versus VD but there is marked variation in self-perceived competency around cesarean-sparing procedures, particularly ECV and breech delivery. These findings can provide useful insights into focus areas for ObGyn training.