JOGNN R ESEARCH Factors Associated with Differences in Canadian Perinatal Nurses’ Attitudes Toward Birth Practices Sarah J. Liva, Wendy A. Hall, Michael C. Klein, and Sabrina T. Wong Correspondence Sarah J. Liva, MSN, RN, University of British Columbia, T201 2211 School of Nursing, Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada. livas@interchange.ubc.ca Keywords perinatal nurses attitudes birth practices hospital level epidural analgesia personal choices ABSTRACT Objective: To test whether demographic characteristics predict registered nurses’ attitudes toward birth practices. Design: A secondary analysis of a cross-sectional survey, the National Maternity Care Attitudes Survey. Setting: A national survey conducted with health care providers providing maternity care in Canada. Participants: A convenience sample of 545 registered nurses. Methods: Hierarchical regression analysis was used to examine three hypotheses about nurses’ demographic differ- ences in relationship to their attitudes toward birth practices. Attitude scales included acceptability of doulas, effects of routine electronic fetal monitoring, factors decreasing cesarean birth rates, the importance of vaginal birth for women, safety of birth, episiotomy, and epidural analgesia. Results: Tertiary hospital–level of employment was associated with more positive attitudes toward epidural analgesia and less positive attitudes toward the importance of vaginal birth. Nurses working at a tertiary hospital were more likely to select an obstetrician for their own maternity care. Those who worked at a community hospital were more likely to select a family physician. Nurses’ selection of an obstetrician was associated with less positive attitudes toward the safety of birth and importance of vaginal birth and more positive attitudes toward electronic fetal monitoring, episiotomy, and epidural analgesia. Conclusion: Nurses’ attitudes may be influenced by exposure in their workplaces to predominant care providers’ birth practices. Research examining the relationships between nurses’ workplace exposures, attitudes, and practice behaviors is needed to develop understanding about how nurses contribute to rates of intervention in maternity care. JOGNN, 41, 761-773; 2012. DOI: 10.1111/j.1552-6909.2012.01412.x Accepted June 2012 Sarah J. Liva, MSN, RN, is a doctoral student at the School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. Wendy A. Hall, PhD, RN, is a professor in the School of Nursing, University of British Columbia Vancouver, British Columbia, Canada. (Continued) R ates of interventions in Canadian hospitals have created concern for all maternity care disciplines (Society of Obstetricians & Gynecolo- gists of Canada [SOGC], 2008). Evidence sug- gests regular use of some interventions is un- warranted because this use may not contribute to improved neonatal and maternal outcomes in low-risk situations and may increase neonatal and maternal morbidity. For example, in comparison to vaginal birth, cesarean birth has been linked to increased neonatal and maternal morbidity and mortality (Liu et al., 2007; Villar et al., 2007). Con- tinuous electronic fetal monitoring is associated with a higher risk of operative vaginal birth and cesarean birth (Alfirevic, Devane, & Gyte, 2006), whereas epidural analgesia has been linked to an increased risk of oxytocin augmentation and op- erative vaginal delivery (Anim-Soumah, Smyth, & Jones, 2011). Birth processes with high levels of intervention have contributed to negative psycho- logical outcomes, such as post-traumatic stress disorder (Soderquist, Wijma, & Wijma, 2002) and are costly to the health care system, with each cesarean birth estimated to cost $4,600 as com- pared to vaginal birth at $2,700 (Canadian Institute for Health Information [CIHI], 2006). Understanding care providers’ attitudes toward birth practices may help to explain why high rates of intervention persist in low-risk situations (Monari, Di Mario, Faccinetti, & Basevi, 2008; Walker, Shunkwiler, Supanich, Williamsen, & Yen- sch, 2001). Little information is available about registered nurses’ (herein referred to as nurses) at- titudes toward birth practices; most published lit- erature tends to focus on the attitudes of midwives, obstetricians, and general practitioners (Monari et al.; Reime et al., 2004; Smith et al., 2009). The authors report no con- flict of interest or relevant financial relationships. http://jognn.awhonn.org C  2012 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses 761