What do certified nurse-midwives believe? Measuring CNM attitudes towards planned home birth (abstract)

2009    Vedam S, Stoll K, Schummers L. (2009). What do certified nurse-midwives believe? Measuring CNM attitudes towards planned home birth (abstract). Journal of Midwifery and Women’s Health, 54(5): 425.



Purpose: The purpose of this study was to validate a Provider Attitude towards Planned Home Birth scale (PAPHB), and to explore correlates and predictors of certified nurse-midwives’ (CNMs’) attitudes.

Background: Research has demonstrated that provider attitudes towards maternity care options have a significant influence on patient access and choice. A woman’s choice of birthsite may be affected by her provider’s opinion and practice site. Providers may offer birthsite options that are congruent with their own education, experience, and scope of practice.

Methods: A survey instrument, including the PAPHB scale and demographic, education, practice, personal experience, and external barrier variables that may predict attitudes towards home birth was administered to approximately 5000 CNMs. Linear regression modeling identified predictors of attitudes.

Results: Predictors of attitudes towards planned home birth (PHB) include age (P < .001), clinical and educational experiences (P < .001), and level of exposure to PHB. External barriers which predict less favourable attitudes include financial (P = .03) and time (P < .001) constraints, inability to access medical consultation (P < .001), and peer censure (P < .001). Willingness to practice in the home was correlated with CNMs’ confidence in their own management abilities and beliefs about PHB safety.

Conclusions: Choice of practice site and comfort with home birth is influenced by exposure to planned home birth during professional education and practice experiences, as well as inter-professional, logistic, and environmental factors. This research may inform development of curricula to prepare physicians and midwives for out-of-hospital maternity care and collaborative care.