Measuring outcomes of midwifery care: Development of an instrument to assess optimality

Research on the outcomes of midwifery care is hampered by the lack of appro priate instruments that measure both process and outcomes of care in lower risk women. This article describes an effort to adapt an existing measureme nt instrument focused on the optimal outcomes of care (The Optimality Index -US) to reflect the contemporary style of U.S.-based nurse-midwifery practi ce. Evidence for content validity of the instrument was derived from litera ture reports of randomized clinical trials, synthetic reviews, and the clin ical consensus of professional reviewers. Eleven perinatal health professio nals and consumers, representing disciplines of obstetrics and gynecology, midwifery, epidemiology, and neonatology reviewed the instrument. The instr ument was then applied to an existing data set of women who intended to giv e birth at home (N = 1,286 women) to determine its utility in measuring eve nts in the process and outcome of perinatal health care as managed by nurse -midwives. Results suggest that the tool holds promise for use in outcomes studies of U.S. perinatal care. Further testing of the instrument among div erse multicultural population groups, with various providers, and in divers e birth settings is warranted. (C) 2001 by the American College of Nurse-Mi dwives.