‘Where do you want to have your baby?’ Women's narratives of how they chose their birthplace
National guidelines endorse the provision of birthplace choice for women with low-risk pregnancies. Despite the availability of different options (birth centre, home and hospital) and substantial evidence highlighting the benefits of birth outside a hospital setting, the majority of women choose to give birth in a hospital.
This study aimed to: explore how low-risk, first-time mothers chose where to give birth to their babies; and gain an in-depth understanding of what factors influenced women's experiences of decision-making.
A qualitative study with a narrative approach was used. Data were collected using an online questionnaire. Participants were recruited from a social networking site. A purposive sample of nine low-risk, first-time mothers, all of whom were given a choice of birthplace (at least two options), was used.
Two core themes emerged that were considered to influence women's decisions on birthplace: women's expectations of birth, perception of safety and protecting the birthing process; and the influence of the midwife, antenatal education and the partner.
The study reveals that women make choices based on a variety of reasons. However, the findings presented suggest that most women give birth in a hospital as it is still widely considered to be the safest place for women and babies—both by couples themselves and by many health professionals. The challenge is to address this generation of women who believe that hospital is the most appropriate place to give birth, despite evidence to the contrary, and ultimately promote the normality of pregnancy and childbirth.
‘Where do you want to have your baby?’ Most women are faced with this question at their very first midwife appointment. So it is not surprising that ‘choice’ is one of the mantras of the modern age (Symon, 2006). This is particularly true of maternity care within the NHS, and is a key topic resonating throughout the recent publication of the National Maternity Review (2016).
Choice of birthplace for low-risk women is a central theme in current national guidelines and, depending on geographical location and availability, options include an obstetric-led hospital service, a midwife-led birth centre—which might be either stand-alone or alongside hospital services—and birth at home.
The benefits of providing midwife-led care, at home or in a midwife-led birth centre, are well documented (Brocklehurst et al, 2011; Hodnett et al, 2012). The Birthplace study (Brocklehurst et al, 2011) is a seminal research project that was undertaken to compare outcomes in birth settings offered by the NHS. The findings revealed that there was no significant difference in outcomes for perinatal mortality and intrapartum-related neonatal morbidities in any of the midwife-led care settings (home or birth centre) when compared with obstetric-led services. The study also indicated that there were substantially fewer interventions and significantly higher rates of normal birth in all midwife-led settings when compared to obstetric services (Brocklehurst et al, 2011). The authors concluded by endorsing current policies relating to birthplace choice, and emphasised the safety of midwife-led care outside of hospital settings and the associated benefits of such forms of care.
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