title: Nurse-midwives' experiences with planned home birth: impact on attitudes and practice.
abstract: BACKGROUND
  Health care providers' attitudes toward maternity care options influence the nature of informed decision-making discussions and patient choice. A woman's choice of birth site may be affected by her provider's opinion and practice site. The objectives of this study were to describe American nurse-midwives' attitudes toward, and experiences with, planned home birth, and to explore correlates and predictors of their attitudes toward planned home birth as measured by the Provider Attitudes towards Planned Home Birth (PAPHB) scale.
  
  
  METHODS
  A survey instrument, which incorporates the PAPHB and assesses demographic, education, practice, personal experience, and external barrier variables that may predict attitudes toward planned home birth practice, was completed by 1,893 nurse-midwives. Bivariate analysis identified associations between variables and attitudes. Linear regression modeling identified predictors of attitudes.
  
  
  RESULTS
  Variables that significantly predicted favorable attitudes to planned home birth were increased clinical and educational experiences with planned home birth (p < 0.001), increased exposure to planned home birth (p < 0.001), and younger age (p < 0.001). External barriers that significantly predicted less favorable attitudes included financial (p = 0.03) and time (p < 0.001) constraints, inability to access medical consultation (p < 0.001), and fear of peer censure (p < 0.001). Willingness to practice in the home was correlated with factors related to nurse-midwives' confidence in their management abilities and beliefs about planned home birth safety.
  
  
  CONCLUSIONS
  The results suggest that nurse-midwives' choice of practice site and comfort with planned home birth are strongly influenced by the nature and amount of exposure to home birth during professional education or practice experiences, in addition to interprofessional, logistic, and environmental factors. Findings from this research may inform interdisciplinary education and collaborative practice in the area of planned home birth.
authors.affiliation: Division of Midwifery, Department of Family Practice, University of British Columbia, B54-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
authors.forename: Saraswathi
authors.initials: S
authors.lastname: Vedam
authors.forename: Kathrin
authors.initials: K
authors.lastname: Stoll
authors.forename: Sarah
authors.initials: S
authors.lastname: White
authors.forename: Jessica
authors.initials: J
authors.lastname: Aaker
authors.forename: Laura
authors.initials: L
authors.lastname: Schummers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006700:Home Childbirth / Q000009:adverse effects / Q000451:nursing* / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009721:Nurse Midwives / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D011247:Pregnancy; D011361:Professional Competence; D011365:Professional Practice Location; D012449:Safety; D011795:Surveys and Questionnaires; D014481:United States