The influence of emotional labor and emotional intelligence on cesarean section decision-making among midwives and obstetricians in Kosovo: A cross-sectional study using conjoint analysis

INTRODUCTION Cesarean section rates continue to increase worldwide. In 2021, one in every five deliveries was delivered by cesarean section. This is particularly alarming in resource-limited countries such as Kosovo, where the rates continue to increase and vary considerably between hospitals. Understanding the underlying factors that drive the increase and variation of cesarean section rates may help to change these trends. This study investigates how emotional intelligence and emotional labor impact cesarean section decision-making among midwives and obstetricians in Kosovo, along with clinical factors. METHODS We employed a conjoint analysis using a cross-sectional study design to assess preferences that drive decisions for cesarean section. We used the Dutch questionnaire on Emotional Labor, the Assessing Emotions Scale, and the Quality of Decision-making questionnaire, and designed a conjoint questionnaire with 28 hypothetical scenarios. We invited all midwives and obstetricians employed at the Gynecology and Obstetrics Clinic of the University Clinical Centre of Kosovo to participate in the study. The data were collected from January to the end of March 2023. Stata 18 BE was used for statistical computing and data visualization. RESULTS A gestational age of 42 weeks decreased CS likelihood among midwives (OR=0.75; 95% CI: 0.62-0.90, p=0.002). Previous cesarean sections (OR=1.42; 95% CI: 1.11-1.81, p=0.005) and hypertension (OR=1.23; 95% CI: 1.01-1.51, p=0.042) raised CS odds for midwives. A pelvic size of 8 cm significantly increased CS likelihood for midwives (OR=1.70; 95% CI: 1.37-2.09, p<0.001), while a size of 11 cm was protective for both groups (midwives: OR=0.73; 95% CI: 0.57-0.93, p=0.010; obstetricians: OR=0.70; 95% CI: 0.52-0.94, p=0.019). Maternal age of 40 years was significant only for obstetricians (OR=1.43; 95% CI: 1.00-2.06, p=0.052), and university education was significant for midwives (OR=1.19; 95% CI: 1.03-1.37, p=0.020). Non-clinical factors and emotional measures showed no significant or consistent trends in either group. CONCLUSIONS Various clinical and non-clinical factors shape the decision to recommend a cesarean section, with obstetricians and midwives prioritizing these factors differently. These findings underscore the importance of implementing evidence-based practices to enhance maternal and newborn health outcomes in Kosovo and similar settings, while optimizing cesarean decision-making.