Online Program

Access across birth settings: Examining sources of conflict and controversy among maternity providers

Wednesday, November 6, 2013 : 10:50 a.m. - 11:10 a.m.

Saraswathi Vedam, RM, FACNM, MSN, SciD(h.c.), Division of Midwifery, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Background: The US maternity care system is failing to reliably offer high-quality, cost-effective maternity care to all populations, even when women have access to tertiary care centers. Planned home births are associated with excellent outcomes, high patient satisfaction, and cost savings. However, in North America controversy among maternity care providers around appropriate birth setting is pervasive, and research has demonstrated that provider opinion influences patient choice. Methods: Mixed-methods study (survey and focus groups) of attitudes towards home birth among Canadian obstetricians, registered midwives and family physicians. Regression analyses revealed covariates of attitudes (as measured with a 17 item scale); qualitative findings explicated the context and etiology of attitudes. Results: Type of care provider accounted for 84% of the variance in attitudes towards home birth. Scale scores for midwives indicated very favorable attitudes towards home birth, whereas physician attitudes were largely unfavorable. Age, birth centre experience, size of practice, and community demand were significantly associated with attitudes among midwives (n=451). Among family physicians (n=139) covariates of attitudes were age, province of practice, exposure to planned home birth during medical education, and/or perceived peer censure. Obstetricians (n=245) universally had no exposure or only negative exposure to home birth during their education. Findings were strongly reinforced and explicated by qualitative findings obtained via multi-disciplinary focus groups. Implications for health professional education, interprofessional collaboration, and access to high quality maternity care will be discussed. Application of the Provider Attitudes Towards Home Birth Scale in international settings will be described.

Learning Areas:

Implementation of health education strategies, interventions and programs
Provision of health care to the public
Public health or related education

Learning Objectives:
Describe and compare attitudes towards homebirth, for midwives, family physicians, and obstetricians in Canada Identify 2 significant covariates of favorability to planned home births among maternity providers Describe two potential strategies to address interprofessional conflict by applying findings of research to health professional education or policy

Keyword(s): Access and Services, Maternal Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Professor Vedam has been active in setting national and international policy on home birth and midwifery education and regulation. Her scholarly work includes critical appraisal of the literature on safety of home birth, and development of the first US registry of home birth perinatal data. She was principal investigator for the federally funded Canadian Birth Place study, and Chair of the historic multi-disciplinary 2011 Home Birth Consensus Summit.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.