147 Validation of the Birth Beliefs Scale for maternity care professionals in the Netherlands Strengths and limitations Our study shows that the BBS is a valid instrument to examine birth beliefs of maternity care professionals quantitatively and is easy to use as it consists of only eleven items. A strength of this validation study is that it was conducted within the Dutch maternity care system with its distinction between low-risk midwifery-led care and high-risk obstetric-led care. This offers an interesting opportunity for testing discriminant validity. Another strength in testing the validity of the BBS is that we first tested the content validity of the BBS before distributing the questionnaire. During data collection, attention was paid to population variance and geographical spread. Different perspectives were provided by the international and interdisciplinary nature of the research team. A limitation of the study was that few potential confounders were included in the questionnaires. This number of variables were realistic for a validation study of this type, however, future studies using the BBS for professionals would benefit from confirming our findings in a larger population with more demographic characteristics. Conclusion Our study highlights variation in maternity professionals’ birth beliefs and contributes to the growing body of evidence that variation in the beliefs and attitudes of professionals contributes to practice variation in maternity care (10–13,27,28). The BBS is a valid instrument for examining professionals’ birth beliefs and can make maternity care professionals aware of their own beliefs and attitudes. This awareness can help to achieve an appropriate balance between patient preferences and the professional beliefs in shared decisionmaking and can decrease unwarranted practice variation. 6
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