137 Validation of the Birth Beliefs Scale for maternity care professionals in the Netherlands Introduction Practice variation in childbirth interventions is a topic often described, both between (1,2) and within countries (3,4). For example, a large variation in labour induction rates has been described between countries, with rates around five percent in low-income countries and percentages beyond seventy percent in Brazil and Iran (5). A study describing regional induction rates in the Netherlands calculated the lowest rates of induction of labour around 14% and the highest rates over 41% (6). Interventions in childbirth can be lifesaving for both mother and baby, but unnecessary interventions can cause harm to mother and baby, and increase health care costs (5). Practice variation can be essential to provide high quality care adapted to medical conditions or patient preferences. When variation cannot be explained by medical conditions or patients’ preferences and occurs despite strong evidence-based recommendations, it is defined as unwarranted (7,8). Practice variation can be explained by a sociological model that describes factors that interact with practice variation at macro-, meso-, and micro-level (9). Although the model explains mechanisms on different levels, these levels cannot be considered in isolation but are interrelated. At micro-level the interaction is described between the patient and the healthcare professional to achieve individual decision-making (9). In the process of clinical decisionmaking, the professional applies theoretical knowledge to, sometimes complex, individual situations. The values and preferences of the individual patient are explored through shared decision-making, creating a conversation about clinical characteristics and patient preferences. Decision-making at the micro-level appeared to be influenced by the attitude of the healthcare professional (10). Previous research on the attitudes of maternity care professionals has shown that there are differences between disciplines in their attitudes to labour and birth. Obstetricians and other medical staff seemed to generally favour a more interventionist approach to birth, while midwives tended to favour a more physiological approach to birth (11,12). The attitude of a maternity care professionals can influence their patients’ decision-making process about labour and birth. For example, women who receive midwifery care may hold views that are more positive towards natural vaginal childbirth and more negative towards technological birth. Despite overall differences between the attitudes of different maternity care disciplines, there also appeared to be considerable areas of agreement (11). Research among Canadian maternity care professionals has shown that a significant group of obstetricians had attitudes toward maternity care similar to those of the majority of midwives, even on contentious issues (11). This similarity is a possible explanation for the variation in intervention rates between different maternity units and regions within countries (4,13). In 6
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