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The Canadian birth place study: examining maternity care provider attitudes and interprofessional conflict around planned home birth

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dc.contributor.author Vedam, Saraswathi
dc.contributor.author Stoll, Kathrin
dc.contributor.author Schummers, Laura
dc.contributor.author Fairbrother, Nichole
dc.contributor.author Klein, Michael C
dc.contributor.author Thordarson, Dana
dc.contributor.author Kornelsen, Jude
dc.contributor.author Dharamsi, Shafik
dc.contributor.author Rogers, Judy
dc.contributor.author Liston, Robert
dc.contributor.author Kaczorowski, Janusz
dc.date.accessioned 2015-05-22T17:13:19Z
dc.date.available 2015-05-22T17:13:19Z
dc.date.copyright 2014 en_US
dc.date.issued 2014-10-28
dc.identifier.citation Vedam et al.: The Canadian birth place study: examining maternity care provider attitudes and interprofessional conflict around planned home birth. BMC Pregnancy and Childbirth 2014 14:353. en_US
dc.identifier.uri http://www.biomedcentral.com/1471-2393/14/353
dc.identifier.uri http://dx.doi.org/10.1186/1471-2393-14-353
dc.identifier.uri http://hdl.handle.net/1828/6197
dc.description BioMed Central en_US
dc.description.abstract 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. en_US
dc.description.sponsorship The authors wish to thank the Canadian Institutes for Health Research for funding this study en_US
dc.language.iso en en_US
dc.publisher BMC Pregnancy and Childbirth en_US
dc.rights Attribution-NonCommercial-NoDerivs 2.5 Canada *
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/2.5/ca/ *
dc.subject Home childbirth en_US
dc.subject Birth place en_US
dc.subject Inter-professional collaboration en_US
dc.subject Scale development en_US
dc.subject Physicians en_US
dc.subject Midwives en_US
dc.subject Psychometrics en_US
dc.title The Canadian birth place study: examining maternity care provider attitudes and interprofessional conflict around planned home birth en_US
dc.type Article en_US
dc.description.scholarlevel Faculty en_US
dc.description.reviewstatus Reviewed en_US


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