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CME Credit Offered
CME Credit Offered
Abstract Award
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 3

Category: Clinical Obstetrics

Poster Session 3

(813) Factors associated with providers’ perspectives on mode of delivery in rural settings

Thursday, February 12, 2026
10:30 AM - 12:00 PM  
Objective:
Epidemiological data suggest women traveling long distances to a delivery hospital are more likely to undergo nonmedically indicated induction of labor (IOL) and less likely to access trial of labor after cesarean (TOLAC), which may increase maternal morbidity and mortality. However, provider-driven contributors to these practices remain unknown.

Study Design:
Cross-sectional online survey of obstetric providers in New York State (9/2024-3/2025). Outcomes were perspective about distance being an indication for IOL and the percentage of time they would recommend TOLAC (vs. repeat cesarean) for patients 50 miles from a hospital. Predictors were profession, litigation concerns, frequency of recommending TOLAC in medical scenarios, perspectives regarding medical scenarios being an indication for IOL, and institutional IOL or TOLAC rates. Analysis included bivariate, generalized linear models, and mediation analysis. 

Results:
Among the 107 participants, 61.3% were physicians and 32.7% were midwives. Physicians more often considered distance > 50 miles to be an indication for IOL in of itself (45.1%) compared to midwives (8.6%) (p< .001) and physicians less frequently recommended TOLAC compared to midwives (z=3.49, p< .001). The IOL and TOLAC models were well-fitting (Table 1). Perspectives on IOL in medical scenarios (aOR=1.3) was the only significant predictor for perspectives on IOL in rural settings. Frequency of TOLAC recommendations in medical scenarios (aOR=10.4) and litigation concerns (aOR=1.8) were significant predictors of the TOLAC recommendation in rural settings. Medical scenario perspectives fully mediated the association between profession and TOLAC recommendations and partially mediated perspectives on IOL in rural settings (Figure 1).

Conclusion:

Perspectives on delivery mode for rural patients are strongly influenced by profession, affecting overall views on IOL and TOLAC in medical scenarios. Litigation concerns also impacts TOLAC access. Shifting practice perspectives and expanding midwifery services could improve access to safe delivery options for rural patients.