title: The Canadian Birth Place Study: describing maternity practice and providers' exposure to home birth.
abstract: OBJECTIVE
  (1) to describe educational, practice, and personal experiences related to home birth practice among Canadian obstetricians, family physicians, and registered midwives; (2) to identify barriers to provision of planned home birth services, and (3) to examine inter-professional differences in attitudes towards planned home birth.
  
  
  METHODS
  the first phase of a mixed-methods study, a quantitative survey, comprised of 38 items eliciting demographic, education and practice data, and 48 items about attitudes towards planned home birth, was distributed electronically to all registered midwives (N=759) and obstetricians who provide maternity care (N=800), and a random sample of family physicians (n=3,000).
  
  
  METHODS
  Canada. This national investigation was funded by the Canadian Institutes for Health Research.
  
  
  METHODS
  Canadian registered midwives (n=451), obstetricians (n=245), and family physicians (n=139).
  
  
  RESULTS
  almost all registered midwives had extensive educational and practice experiences with planned home birth, and most obstetricians and family physicians had minimal exposure. Attitudes among midwives and physicians towards home birth safety and advisability were significantly different. Physicians believed that home births are less safe than hospital births, while midwives did not agree. Both groups believed that their views were evidence-based. Midwives were the most comfortable with including planned home birth as an option when discussing choice of birth place with pregnant women. Both midwives and physicians expressed discomfort with inter-professional consultation related to planned home births. In addition, both family physicians and obstetricians reported discomfort with discussing home birth with their patients. A significant proportion of family physicians and obstetricians would have liked to attend a home birth as part of their education.
  
  
  CONCLUSIONS
  the amount and type of education and exposure to planned home birth practice among maternity care providers were associated with attitudes towards home birth, comfort with discussing birth place options with women, and beliefs about safety. Barriers to home birth practice across professions were both logistical and philosophical.
  
  
  CONCLUSIONS
  formal mechanisms for midwifery and medical education programs to increase exposure to the theory and practice of planned home birth may facilitate evidence based informed choice of birth place, and increase comfort with integration of care across birth settings. An increased focus among learners and clinicians on reliable methods for assessing the quality of the evidence about birth place and maternal-newborn outcomes may be beneficial.
authors.affiliation: Division of Midwifery, Department of Family Practice, University of British Columbia, Canada. vedam@midwifery.ubc.ca
authors.forename: Saraswathi
authors.initials: S
authors.lastname: Vedam
authors.forename: Laura
authors.initials: L
authors.lastname: Schummers
authors.forename: Kathrin
authors.initials: K
authors.lastname: Stoll
authors.forename: Judy
authors.initials: J
authors.lastname: Rogers
authors.forename: Michael C
authors.initials: MC
authors.lastname: Klein
authors.forename: Nichole
authors.initials: N
authors.lastname: Fairbrother
authors.forename: Shafik
authors.initials: S
authors.lastname: Dharamsi
authors.forename: Robert
authors.initials: R
authors.lastname: Liston
authors.forename: Gua Khee
authors.initials: GK
authors.lastname: Chong
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D003266:Continuity of Patient Care / Q000458:organization & administration; D003299:Cooperative Behavior; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007400:Interprofessional Relations; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D008880:Midwifery / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010820:Physicians / Q000706:statistics & numerical data*; D011247:Pregnancy; D011361:Professional Competence; D011368:Professional-Family Relations; D055815:Young Adult