TY - JOUR
T1 - The Canadian birth place study
T2 - Examining maternity care provider attitudes and interprofessional conflict around planned home birth
AU - Vedam, Saraswathi
AU - Stoll, Kathrin
AU - Schummers, Laura
AU - Fairbrother, Nichole
AU - Klein, Michael C.
AU - Thordarson, Dana
AU - Kornelsen, Jude
AU - Dharamsi, Shafik
AU - Rogers, Judy
AU - Liston, Robert
AU - Kaczorowski, Janusz
N1 - Funding Information:
The authors wish to thank the Canadian Institutes for Health Research for funding this study, and the Canadian Association of Midwives and the Society of Obstetricians and Gynaecologists of Canada for their endorsement and support of this study. In addition, the team thanks Gua Khee Chong, Colleen Fulton, and Kerri Blackburn, Research Assistants and Karen Gelb, Research Manager with the UBC Division of Midwifery, for their assistance with coordination of the Canadian Birth Place Study and manuscript development.
Funding Information:
We assessed the psychometric properties of a comprehensive survey of attitudes towards planned home birth among physicians and midwives. The survey items were adapted to the Canadian context and for all maternity provider groups from an instrument which was developed and validated with a single provider group (midwives) in the US [35]. The survey was designed to measure the construct “attitudes to home birth” in four subdomains: the safety of planned home birth, maternal/newborn outcomes from planned home births, maternal/newborn benefits from home births, and inter-professional experiences and engagement with home birth practice. Content validation of the Canadian Birth Place survey instrument by provider-specific expert panels, and pilot testing by physician and midwife resident learners, are described elsewhere [24]. The study was funded by the Canadian Institutes of Health Research and led by a multi-disciplinary team of investigators. Ethics approval was obtained from the University of British Columbia.
Publisher Copyright:
© 2014 Vedam et al.
PY - 2014/10/28
Y1 - 2014/10/28
N2 - Background: Available birth settings have diversified in Canada since the integration of regulated midwifery. Midwives are required to offer eligible women choice of birth place; and 25-30% of midwifery clients plan home births. Canadian provincial health ministries have instituted reimbursement schema and regulatory guidelines to ensure access to midwives in all settings. Evidence from well-designed Canadian cohort studies demonstrate the safety and efficacy of midwife-attended home birth. However, national rates of planned home birth remain low, and many maternity providers do not support choice of birth place. Methods: In this national, mixed-methods study, our team administered a cross-sectional survey, and developed a 17 item Provider Attitudes to Planned Home Birth Scale (PAPHB-m) to assess attitudes towards home birth among maternity providers. We entered care provider type into a linear regression model, with the PAPHB-m score as the outcome variable. Using Students' t tests and ANOVA for categorical variables and correlational analysis (Pearson's r) for continuous variables, we conducted provider-specific bivariate analyses of all socio-demographic, education, and practice variables (n=90) that were in both the midwife and physician surveys. Results: Median favourability scores on the PAPHB-m scale were very low among obstetricians (33.0), moderately low for family physicians (38.0) and very high for midwives (80.0), and 84% of the variance in attitudes could be accounted for by care provider type. Amount of exposure to planned home birth during midwifery or medical education and practice was significantly associated with favourability scores. Concerns about perinatal loss and lawsuits, discomfort with inter-professional consultations, and preference for the familiarity of the hospital correlated with less favourable attitudes to home birth. Among all providers, favourability scores were linked to beliefs about the evidence on safety of home birth, and confidence in their own ability to manage obstetric emergencies at a home birth. Conclusions: Increasing the knowledge base among all maternity providers about planned home birth may increase favourability. Key learning competencies include criteria for birth site selection, management of obstetric emergencies at planned home births, critical appraisal of literature on safety of home birth, and inter-professional communication and collaboration when women are transferred from home to hospital.
AB - Background: Available birth settings have diversified in Canada since the integration of regulated midwifery. Midwives are required to offer eligible women choice of birth place; and 25-30% of midwifery clients plan home births. Canadian provincial health ministries have instituted reimbursement schema and regulatory guidelines to ensure access to midwives in all settings. Evidence from well-designed Canadian cohort studies demonstrate the safety and efficacy of midwife-attended home birth. However, national rates of planned home birth remain low, and many maternity providers do not support choice of birth place. Methods: In this national, mixed-methods study, our team administered a cross-sectional survey, and developed a 17 item Provider Attitudes to Planned Home Birth Scale (PAPHB-m) to assess attitudes towards home birth among maternity providers. We entered care provider type into a linear regression model, with the PAPHB-m score as the outcome variable. Using Students' t tests and ANOVA for categorical variables and correlational analysis (Pearson's r) for continuous variables, we conducted provider-specific bivariate analyses of all socio-demographic, education, and practice variables (n=90) that were in both the midwife and physician surveys. Results: Median favourability scores on the PAPHB-m scale were very low among obstetricians (33.0), moderately low for family physicians (38.0) and very high for midwives (80.0), and 84% of the variance in attitudes could be accounted for by care provider type. Amount of exposure to planned home birth during midwifery or medical education and practice was significantly associated with favourability scores. Concerns about perinatal loss and lawsuits, discomfort with inter-professional consultations, and preference for the familiarity of the hospital correlated with less favourable attitudes to home birth. Among all providers, favourability scores were linked to beliefs about the evidence on safety of home birth, and confidence in their own ability to manage obstetric emergencies at a home birth. Conclusions: Increasing the knowledge base among all maternity providers about planned home birth may increase favourability. Key learning competencies include criteria for birth site selection, management of obstetric emergencies at planned home births, critical appraisal of literature on safety of home birth, and inter-professional communication and collaboration when women are transferred from home to hospital.
KW - Birth place
KW - Home childbirth
KW - Inter-professional collaboration
KW - Midwives
KW - Physicians
KW - Psychometrics
KW - Scale development
UR - http://www.scopus.com/inward/record.url?scp=84927526383&partnerID=8YFLogxK
U2 - 10.1186/1471-2393-14-353
DO - 10.1186/1471-2393-14-353
M3 - Article
C2 - 25352366
AN - SCOPUS:84927526383
SN - 1471-2393
VL - 14
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
IS - 1
M1 - 353
ER -