145 Validation of the Birth Beliefs Scale for maternity care professionals in the Netherlands Box 2. Estimates based on the regression model for different disciplines MCN with a low % IOL BBS-Nat community midwife = 4,281 + (-0,006*years of work experience) BBS-Nat hospital-based midwife = 4,098 + (0,014*years of work experience) BBS-Nat obstetrician = 3,225 + (0,01*years of work experience) MCN with a high % IOL BBS-Nat community midwife = 4,449 + (-0,009*years of work experience) BBS-Nat hospital-based midwife = 3,760 + (0,022*years of work experience) BBS-Nat obstetrician = 2,956 + (0,009*years of work experience) Discussion The findings from the current study indicate that the BBS in this Dutch translation is a valid instrument for measuring birth beliefs among maternity care professionals. In addition to a good score on content validity and internal reliability, the known-group discriminant validity testing revealed statistical significant differences as a function of the discipline of maternity care professional (community midwives, hospital-based midwives, obstetricians) on BBS-Natural and BBS-Medical subscales. Significant associations were found between years of work experience, discipline, and type of MCN with the BBSNatural subscale. None of the investigated factors other than discipline had a significant association with the BBS-Medical subscale. This states the Birth Beliefs Scale as a valid instrument for examining birth beliefs among professionals and could make maternity care professionals aware of their own beliefs and attitudes. Subsequently, this can help to achieve an appropriate balance between patient preferences and the professional beliefs in shared decision-making and can decrease unwarranted practice variation. Comparison between different disciplines This study confirmed our hypothesis that birth beliefs differ between maternity care professionals, and this is consistent with the findings of previous studies (11,12). Differences in birth beliefs between maternity care professionals may be the result of the paradigm that influences the way they act. A higher score on the BBS-Med subscale for obstetricians suggests a more medical, interventionist approach where childbirth is seen as a medical condition with treatable risks, whereas a higher score on the BBS-Nat subscale for midwives fits with the midwifery philosophy that childbirth is a physiological, natural process (22). 6
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