Giving birth is relatively safe in the wealthiest parts of the world1. However, there are puzzling variations in delivery outcomes and intervention rates between different high-income countries, and between maternity units within the same country, regardless of universal coverage and standardized care2,3. Decisions and actions affecting childbirth, particularly during emergencies, often emerge from the coordinated efforts of the obstetric personnel4,5. Nevertheless, the resilience and success of the group will be dependent on the individuals’ competence, characteristics, and adaptability4,6,7. Such individual differences and the resulting variations in response to similar emergency situations can be seen as the result of personality traits8,9. Scientifically, personality traits are organized according to the Five Factor Model (FFM; Neuroticism (e.g., emotional instability, anxiety and pessimism), Extraversion (e.g., sociability and assertiveness), Openness (e.g., intellect and curiosity), Agreeableness (e.g., compassion and civility) and Conscientiousness (e.g., responsibility and achievement))10,11. The replicable framework of the FFM has led to a substantial research literature linking personality to various individual, interpersonal, and social-institutional outcomes8,9,11,12. For physicians working in obstetric care, only a few studies have discussed the impact of personality on the choice of this specialty, on physicians’ responses to emergency stress, on teamwork, or obstetrical outcomes13,14,15,16,17. To the best of our knowledge no previous research has explored the personality of obstetricians and gynecologists in relationship to decision-making during childbirth emergencies. The aims of this study were: (I) to describe the personality trait levels of obstetricians and gynecologists and (II) to examine the relationship between obstetricians’ and gynecologists’ personality traits and decision-making styles in childbirth emergencies.


Ethics declaration

The study was approved by the regional ethics review board (Lund University, permit number LU 2018/198). Informed consent was obtained from the study participants. Participation could be terminated at any time. All methods were carried out in accordance with relevant guidelines and regulations.


See Supplementary Questionnaire S1. Personality traits were assessed using a shorter 30-item version of the FFM standardized psychometric pool of items (IPIP-NEO; See The measure consists of 6 items for each of the five factors on a Likert-scale 1 (not at all, almost never) to 5 (very much, almost always). Decision-making was assessed using 15 questions reflecting three decision-making styles: an individual-centered, a team-based and a flow-oriented (See Table 1 for items for each decision-making style). These items were based on the results from a previous study19 and are also supported by evidence from the literature16,20,21,22,23,24,25,26. The same Likert-scale was used for measure. Control variables, acting as covariates in our analyses were cognitive ability, age, sex and years of clinical experience. Cognitive ability was assessed using 3 spatial items in the form of three cube rotations from the International Cognitive Ability Resource (ICAR-3; See

Table 1 Three decision-making styles during childbirth emergencies.

Sample and procedure

The questionnaire was sent out to all Swedish obstetricians and gynecologists, members of the Swedish Society for Obstetrics and Gynecology during 2 months in 2020. According to the organization’s 2019 annual report, it comprised 2180 members, including 480 retired physicians. Of the initial 513 responses forty-one were excluded, due to erratic or duplicate responses. A sample of N = 472 (79% women, MAge = 46.4 years, 28–90 years) which we call Ob&Gyn was used for all analyses. All sample characteristics are shown in Table 2. The number of respondents from each of the six health care districts in Sweden was proportional to the number of its inhabitants and births (Supplementary Fig. S2). The personality trait levels in Ob&Gyn were also compared with the general population. A sample from the general Swedish population (N = 1943) was used as reference group. This sample was collected via an anonymous voluntary personality-testing website, using the same items (IPIP-NEO) as the present study18. The number of women and men in the reference sample was approximately equal (48% women, MAge = 29.6 years, 19–66 years).

Table 2 Descriptive characteristics of the Ob&Gyn sample (N = 472).

Statistical analyses

If Levene's test was significant (P < 0.05), suggesting a violation of the assumption of equal variances, Welch’s t-test instead of Student’s t-test, was used for comparisons. Reliability analyses were conducted with Cronbach’s alpha. Zero-order Pearson’s correlations were used to assess relationships between personality traits and decision-making styles. Multiple linear regression analysis was performed for each dependent decision-making style Individual, Team and Flow with all five personality traits, together with covariates as independent variables. The following cut-off values were used to assess the strength of a correlation or regression estimate: r ≥ 0.30, a strong correlation and r ≤ 0.20 a weak correlation29. A preparatory power calculation aiming to find effects larger than r > 0.15 (α = 0.01, 75% power) indicated a sample size of N = 46530. All statistical analyses were performed using the open source program Jamovi, v. 2.3.21.


In order to test the first aim of the study, the levels of personality traits in obstetricians and gynecologists were assessed and are described in Table 2. Agreeableness showed the highest levels, while Neuroticism the lowest. Average length of clinical experience was 15.5 years. Women scored higher than men in Neuroticism (d = 0.45), Agreeableness (d = 0.55) and Conscientiousness (d = 0.31). To further understand personality trait levels with obstetricians and gynecologists, the results were compared to a Swedish reference group (N = 1943). A Welch’s t-test showed very large differences with obstetricians and gynecologists having lower scores in Neuroticism (d = − 1.09), higher in Extraversion (d = 0.79), Agreeableness (d = 1.04) and Conscientiousness (d = 0.97). The second aim was to evaluate correlations between the five personality traits and three decision-making styles (Table 3). The results showed that Neuroticism was negatively correlated with Individual decision-making, and slightly positive with Team decision-making. Overall, Extraversion, Openness, Agreeableness were positively correlated with both Individual and Team decision-making, as well as each other. The correlations between decision-making styles were overall small.

Table 3 Correlations between personality traits and decision-making styles.

Two step multiple linear regressions, one for each decision-making style, and with covariates were also conducted (Table 4). After controlling for age, sex, and clinical experience, Neuroticism was still significantly (P < 0.001) negatively related to the Individual decision-making style. Women and older age were positively related to Team; while the more years of clinical experience the less decision-making was based on Team. Cognitive ability did not show any relationships to decision-making style.

Table 4 Regression models: the effects of personality traits on the decision-making styles.


The present study showed that Swedish obstetricians and gynecologists have notably different personality trait levels on four out of five trait factors (including lower Neuroticism and higher Extraversion, Agreeableness, and Conscientiousness) compared to the general Swedish population. Such differences are not unusual to find in the literature regarding linkage between personality and occupational choices12 or academic disciplines31. It may be that Swedish obstetrics oriented physicians choose and thrive in what best suits their personality trait levels. Childbirth emergencies are potentially high stake situations that can quickly escalate to crisis32. It is in this setting that physicians’ personalities are put to the test19. A lower level of Neuroticism would be an advantage for dealing with stress and uncertainty in such moments33,34. Similarly, a higher level of Extraversion, being comfortable in taking lead as well as enjoying a team challenge, would also be an advantage33. Higher levels of Agreeableness, especially combined with a high level of Conscientiousness, would be favorable in situations that naturally involve following procedure and check lists while interacting with team members, particularly during emergencies35. Further research into what motivates physicians to choose and stay in the specialty of obstetrics and gynecology would be valuable. The present study also showed that personality can predict which decision-style that is preferred. Low Neuroticism, which stands for emotional stability, was the most important trait, showing non-trivial effects even after controlling for cognitive ability, age, sex, and clinical experience. Neuroticism is characterized by anxiety and vulnerability to stress and showed a negative relationship with Individual decision-making and a positive with Team decision-making. A more positive aspect of Neuroticism has been shown to translate into caution and dialogue with peers36,37. Women are also known to have higher Neuroticism than men and to take fewer risks38. Also, Neuroticism is known to be tempered with age9. Concerning clinical experience, the results showed a negative relationship to the Team-style, which suggest that the less experienced physicians are, the more they turn to a Team-based decision-making. Today there is a consensus that teamwork is not only an essential normal part of daily work, but also the key to solving many complex clinical problems22,23,39,40,41. Also, Openness showed a relationship with the Team-style, working with others, as well as with the Flow-style, which also is in line with the nature of Openness, a trait characterized by listening in to others, as well as having the liking to be immersed in an intuitive kind of decision-making. Overall, the present study show indications that the Team-style of decision-making is facilitated by the traits of Neuroticism, Agreeableness, and Openness, especially by older women, with fewer years of clinical experience. The results give an enhanced comprehension of the various factors, including personality traits, affecting the physicians' decision-making processes during childbirth. An individual-centered or a team-based approach may be appropriate depending on the individual. This may be surprisingly relevant even in a highly organized and protocol-driven environment such as emergency obstetrics. In the future, it may be of value to incorporate clinical experience and personality when selecting candidates for the Obstetrics and Gynecology specialty, trainee education, and the assessment of medical errors related to childbirth.


There are several limitations to the present study. Concerning the first aim, to describe the personality trait levels of obstetricians and gynecologists, even though using the same personality instrument (IPIP-NEO) the reference sample used for comparison was much younger and from various professional backgrounds. It is precarious to draw strong conclusions from these analyses; however, the effect sizes were very large. One standard deviation of difference in for instance Neuroticism, Agreeableness, and Conscientiousness converts into 85% of all the Ob&Gyn sample practitioners having trait levels above the reference sample mean. Similarly, the reference sample unlike the Ob&Gyn sample was evenly distributed in men and women, which likely could explain part of the difference, especially in Neuroticism and Agreeableness. Furthermore, it may be that the physicians who chose to take the time and effort to answer the questionnaire were characterized by higher Agreeableness, and Conscientiousness thus inflating the differences by selection bias.

Nevertheless, this is likely the first time this particular profession has been evaluated based on the Five Factor Model of personality. Concerning the second aim, predicting decision-making based on personality traits for childbirth emergencies in real time is a complex phenomenon and conceptualization into styles, as attempted for the purpose of this study may be insufficient4,32,42. Arguably, the somewhat low reliabilities (Cronbach’s alphas.60–.67) support this notion. It could also be debated whether controlling for cognitive ability, age, sex, and clinical experience was meaningful, seeing how the study aim was to focus on personality traits in relation to decision-making. Personality traits do differ between age groups, between sexes, and for those who stay in the profession long enough to gain clinical experience, which now are obscured within the covariates. Due to this, along with the modest reliabilities with decision-making styles, we also presented disattenuated correlations in Table 3. Common method variance, which is the tendency of participants to somewhat agree with items, might also have confounded the results somewhat43. This effect is likely only in parity with the smallest correlation (r = 0.09), found between decision-making styles. Further explorations regarding the role of personality traits in decision-making styles during childbirth emergencies is warranted.