Development of the Preparation for Community-Based Labor and Birth Instrument Centering Black Perspectives in the United States: A Participatory Adaptation.
Ashley Mitchell, Nikia Grayson, Patience A Afulani and 4 others
PMID 41152197WHAT IT FOUND
A childbirth-confidence questionnaire was adapted for people planning home or birth-center births, centering Black perspectives and adding items on safety, dignity, and racial identity.
It is a tool for conversation, not yet a tested measure of birth outcomes.
Key findings
01The adapted P-CLAB instrument has 23 items for confidence in physiologic birth in community settings.
02Expert review removed 6 items, revised 8 items, and added 6 items focused on community birth and Black perspectives.
03Community interviews changed wording and added one item about being listened to and believed.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The adaptation was done at one birth center, whose patients are relatively similar in race and sociocultural status, so the items may not fit other groups or settings. The stakeholder samples were small: five written expert ratings, three group reviewers, ten community interviews, and five pretest participants. Psychometric testing is ongoing, so the paper does not show that the 23 items measure confidence accurately or predict birth experiences. Pretest participants had already given feedback on the items, which may have shaped their answers. The paper reports no patient outcomes, intervention effects, or comparison groups.
Declared interests
The supplied text does not report funding sources or author conflicts of interest. It notes partnership with CHOICES and ethics approval by UCSF. Participants received gift cards: $50 for experts, $40 for community interviews, and $10 for the pretest.
The easy way to misread this
Do not read the P-CLAB as a proven way to increase childbirth confidence or reduce interventions. The paper describes item adaptation and stakeholder feedback, not patient outcomes, and psychometric validation is ongoing.