Get access

Measuring Outcomes of Midwifery Care: Development of An Instrument To Assess Optimality


  • Patricia Aikins Murphy CNM, DrPH, FACNM,

    Corresponding author
      148 Concord Drive, River Edge, NJ 07661.
    Search for more papers by this author
    • Patricia Aikins Murphy received her midwifery education and a master's degree in nursing from Columbia University, NY, and her doctorate in public health from the Columbia University School of Public Health. She is an Associate Research Scientist in the Department of Obstetrics and Gynecology at Columbia University, where she is engaged in research, education, and clinical practice, with a focus on midwifery and women's health.

  • Judith T. Fullerton CNM, PhD, FACNM

    Search for more papers by this author
    • Judith T. Fullerton received her bachelor of science degree in nursing from Wayne State University, Detroit, MI, her master of science degree and certificate in nurse-midwifery from Columbia University, NY, and her doctorate in health education and health administration from Temple University, Philadelphia, PA. She holds the distinction of Distinguished Fellow, American College of Nurse-Midwives, and the Hattie Hemschemeyer Award from the American College of Nurse-Midwives. Dr. Fullerton holds an academic appointment as Professor, School of Nursing, College of Health Sciences, University of Texas at El Paso. She has specific expertise in measurement and evaluation, with application to health professional credentialing and outcomes research in women's health.

148 Concord Drive, River Edge, NJ 07661.


Research on the outcomes of midwifery care is hampered by the lack of appropriate instruments that measure both process and outcomes of care in lower risk women. This article describes an effort to adapt an existing measurement instrument focused on the optimal outcomes of care (The Optimality Index—US) to reflect the contemporary style of U.S.-based nurse-midwifery practice. Evidence for content validity of the instrument was derived from literature reports of randomized clinical trials, synthetic reviews, and the clinical consensus of professional reviewers. Eleven perinatal health professionals and consumers, representing disciplines of obstetrics and gynecology, midwifery, epidemiology, and neonatology reviewed the instrument. The instrument was then applied to an existing data set of women who intended to give birth at home (N = 1,286 women) to determine its utility in measuring events in the process and outcome of perinatal health care as managed by nurse-midwives. Results suggest that the tool holds promise for use in outcomes studies of U.S. perinatal care. Further testing of the instrument among diverse multicultural population groups, with various providers, and in diverse birth settings is warranted.

Get access to the full text of this article