194 Chapter 9 Chapter 7 In this validation study, we explored if the Birth Beliefs Scale (BBS) can be used to measure beliefs about birth among maternity care professionals in the Netherlands. The BBS questionnaire consists of eleven items that are rated on a five-point Likert scale. The BBS has been validated for pregnant women, and differentiates between views of birth as a natural process (BBS-Nat) and as a medical process (BBS-Med). The study aimed to assess the scale’s content validity, internal reliability, known-group discriminant validity. To establish content validity, the BBS was reviewed by an expert panel. Item 6 was adjusted, before the questionnaire was distributed. In total, 199 maternity care professionals, including community midwives, hospital-based midwives, and obstetricians completed the questionnaire. Data collection took place between November 2022 and March 2023. A good internal reliability of the BBS was found, indicating consistency in measuring the constructs of medical and natural childbirth beliefs. Natural and medical birth beliefs differed between community midwives, hospitalbased midwives, and obstetricians. Community midwives had the highest scores on the natural birth beliefs scale, followed by hospital-based midwives, and obstetricians showed the lowest score. For the medical birth beliefs scale an inverse scoring pattern was seen, with the highest score for obstetricians, followed by hospital-based midwives and the lowest scores for community midwives. Regression analysis indicated that work experience and the type of MCN influenced the scores on the natural birth beliefs scale. We showed that the BBS is a valid tool for assessing childbirth beliefs among maternity care professionals. The BBS can help to create awareness within professionals of their beliefs and may help to explain practice variation in childbirth. Chapter 8 | General discussion This thesis give a broad view of a number of factors that are potential explanations for practice variation in maternity care. It describes exploratory research on the variation in childbirth interventions in the Netherlands and generates further knowledge about how personal and professional factors are related to midwives’ clinical decisions about the use of childbirth interventions. We reflected on our outcomes using the sociological model of practice variation and Sutherland and Levesque’s framework, which can be used to assess whether the variation is warranted or unwarranted. National guidelines and regional protocols provide an opportunity for the detailed, evidence-based description of medical practice, however, they should not promote undesirable standardisation of care. Too much standardisation in regional protocols can decrease the existing room for
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