Assessing certified nurse-midwives' attitudes towards planned home birth

Certified nurse-midwives (CNMs) and certified midwives (CMs) are prepared for care in many settings and could increase access to planned home birth for American women. However, only 4% of American College of Nurse-Midwives members offer the home as a birth setting. CNMs'/CMs' attitudes towards birth place and the factors underlying their choice of practice site are largely unstudied. This article describes the development, content validation, and psychometric testing of an instrument to assess the attitudes of CNMs towards planned home birth.

A scale was designed to measure Provider Attitudes to Planned Home Birth (PAPHB). Item generation was informed by literature review and a systematic expert panel appraisal. Reliability and validity of the scale were evaluated with a sample of 1893 CNMs.

Expert review indicated high relevancy and clarity of the scale items (scale-content validity index, 0.93). Construct validity was assessed using the Cattell scree test and factor analysis. The resultant 1-factor, attitude scale had strong internal consistency (Cronbach alpha = .94). The average PAPHB scale score among CNMs was 78.77 (range, 20-100; standard deviation, 15.9), with significant differences in attitude scores according to clinical home birth experience, educational background, and external barriers reported by CNMs.

The PAPHB scale is a reliable and valid instrument for the measurement of attitudes towards home birth. It can be used to assess the impact of education, environment, and clinical experiences on maternity practice choices.