The Birth Place Lab has developed novel instruments to improve the evaluation of maternity care, measure respectful care, and measure provider attitudes to planned home birth. Find Frequently Asked Questions about our tools here.

Instruments to improve the evaluation of perinatal services

Measuring respectful care

Mothers Autonomy in Decision Making scale (MADM)

The Mothers Autonomy in Decision Making scale (MADM) is a scale developed to assess women’s experiences with maternity care.

It is a reliable and valid instrument, presently MADM version 1.0 is the most recent version and should be used for all new studies.


Vedam S, Stoll K, Martin K, et al. The Mother’s Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care. PLOS ONE

See "Requesting MADM and MOR" below for information on requesting a copy.

Mothers on Respect Index (MOR)

The Mothers on Respect index (MOR) is a scale developed to assess the nature of respectful patient-provider interactions and their impact on a person’s sense of comfort, behavior, and perceptions of racism or discrimination. The MOR index is a reliable, patient-informed quality and safety indicator that can be applied across jurisdictions to assess the nature of provider-patient relationships, and access to person-centered care. (Vedam et al, 2017) It is a consumer driven, reliable and valid instrument that has been administered to women in Canada and the US (see paper).


Vedam S, Stoll K, Rubashkin N, et al. The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirthSocial Science and Medicine: Population Health.

Requesting MADM and MOR

These instruments are available for use with the required appropriate attribution.

Any study carried out by governmental or commercial entities, or if the study is wholly or partially supported by a commercial or governmental organization or grant, authorized use is required and a licensing fee may apply.

For more information, please contact the BPL here.

The Mistreatment Index (MIST)

The Mistreatment Index (MIST) is a set of patient designed indicators of mistreatment that align with the seven dimensions of mistreatment identified by the Bohren typology. These seven components are: physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and poor conditions and constraints presented by the health system. This scale has been used in a national study in the US (see citation and Pregnant persons can use this index to identify which, if any of the dimensions of mistreatment they may have experienced in their maternity care. Learn more about the development of this index here.


Vedam, S., Stoll, K., Taiwo, T. K., Rubashkin, N., Cheyney, M., Strauss, N., . . . & the GVtM-US Steering Council. (2019). “The Giving Voice to Mothers study: Inequity and mistreatment during pregnancy and childbirth in the United States”. Reproductive Health, June 11, 1-18. DOI: 10.1186/s12978-019-0729-2

Place of Birth:

The Birth Place Research Quality Index (ResQu Index)

Families, doctors, midwives and policymakers often make decisions about where to plan a birth based on their understanding of the published research. However, they sometimes draw different conclusions about the safety of home, birth center or hospital birth, even when they read the same studies.  This is, in part, because there has been no standardized way to assess the quality of the available studies. The Birth Place Research Quality Index (ResQu Index) was designed to provide a reliable instrument to rate the quality of primary research that examines the impact of place of birth to maternal and newborn outcomes.

An international, multi-disciplinary panel of experts developed the ResQu Index.  It is a reliable and practical tool that can be used to rate the quality of research that examines the effects of birth place on health outcomes. The components of the index meet best practice standards for critical appraisal tools.

Click below to receive a copy of the research article, tool, or lay summary.

Provider Attitudes to Planned Home Birth (PAPHB) Scale

The Birth Place Lab has developed 3 scales that can measure provider attitudes toward planned home birth. These scales, originally developed in 2009, have been used by researchers internationally including Australia, Ireland, Israel, Jamaica and the United States. There are three versions available: PAPHB, designed for Certified Nurse Midwives; PAPHB-M (multidisciplinary) which is designed for use across health disciplines; and PAPHB-I (international) which can compare attitudes among midwives from different countries.


Vedam S, Stoll K, Acker J, White S. & Schummers L. (2009). Nurse midwives’ experiences with planned home birth: impact on attitudes and practice. Birth. 36(4):274-82. PMID: 20002419