Assessing Certified Nurse-Midwives' Attitudes Towards Planned Home Birth


  • Saraswathi Vedam MSN, CNM,

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    • Saraswathi Vedam, RM, CNM, MSN, Sci D (h.c.), is Director of the Division of Midwifery at University of British Columbia, Vancouver, British Columbia, Canada; Chair of the Home Birth Section of the American College of Nurse-Midwives' Division of Standards and Practice; and Chair of Knowledge Translation for the Midwives Alliance of North America Division of Research.

  • Jessica Aaker CNM, MSN,

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    • Jessica Aaker, CNM, MSN, is a certified nurse-midwife who currently practices in Connecticut at Norwalk Hospital and Norwalk Community Health Center, Norwalk, CT. The content validation portion of this research project was initiated through her master's thesis work at the Midwifery Program Yale School of Nursing, New Haven, CT.

  • Kathrin Stoll MA

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    • Kathrin Stoll, MA, is a doctoral student and Midwifery Research Manager at the University of British Columbia, Vancouver, British Columbia, Canada. Her areas of expertise are quantitative methodology and data analysis.

Division of Midwifery, University of British Columbia, B54–2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada. E-mail:


Introduction: 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.

Methods: 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.

Results: 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 α = .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.

Discussion: 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.