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CME Credit Offered
CME Credit Offered
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Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
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Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 4

Category: Obstetric Quality and Safety

Poster Session 4

(1079) External Influences on Clinicians' Decision-Making During Second Stage Cesarean Delivery: A Grounded Dimensional Analysis

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Objective:
Second stage cesarean delivery demands rapid, critical decision-making in complex clinical environments. This study explored external factors that influence clinicians' decision-making in second stage cesarean delivery. 

Study Design:
Semi-structured interviews were conducted with clinicians who opted in after completing a nationally distributed survey. Interviews inquired about labor and delivery structure, resource availability, delivery techniques, and real-world management implementation. Interviews were recorded, transcribed verbatim, and analyzed using grounded dimensional analysis (GDA). GDA identifies variation in real-world processes to generate a conceptual model explaining key dimensions of clinical decision-making, such as second stage cesarean delivery management.

Results:
A total of 41 clinicians participated and were equally represented by the four main geographic regions in the United States. Most participants were attending physicians specializing in general obstetrics and gynecology or maternal fetal medicine. Four key domains emerged that shaped clinician decision-making during second-stage cesarean delivery: 1) System-level pressures (e.g., liability, institutional policy, cost-containment), 2) Patient-specific factors (e.g., body habitus, fetal position, urgency), 3) Peer and cultural norms (e.g., departmental expectations, informal mentorship), and Resource and real-time constraints (e.g., personnel, equipment, OR readiness) (Figure 1). Representative quotes supporting each domain are presented in Table 1.

Conclusion:
Second stage cesarean delivery decisions are not made in isolation. Rather, clinicians operate within a web of interrelated external influences that shape their actions in real time. The conceptual framework developed from this analysis may guide the design of standardized protocols, targeted team-based training, and system-level interventions to improve the safety, efficiency, and consistency of care in second stage cesarean delivery.