Women’s birthplace decision-making, the role of confidence: part of the Evaluating Maternity Units study, Aotearoa New Zealand.

Abstract

Background: Birthplace is a profoundly important aspect of women's experience of childbirth and midwifery practice. Birthplace decision-making is complex, in common with many other aspects of childbirth. Purpose/Objective: We explored the influences on women's birthplace decision-making in Aotearoa New Zealand (NZ) and identified the factors which enable women to plan to give birth in a freestanding midwifery-led primary level maternity unit (PMU) rather than in an obstetric-led tertiary level maternity hospital (TMH). Method: The prospective cohort study used a mixed method methodology. Data from eight focus groups (37 women) and a six week postpartum survey (571 women, 82%) were analysed using thematic analysis and descriptive statistics. Participants were well, pregnant women booked to give birth in a PMU or TMH in Christchurch, NZ (2010-2011). The participants received continuity of midwifery care regardless their intended or actual birthplace. Key Findings: Almost all the participants perceived themselves as the primary birthplace decision-makers. Accessing a ‘specialist facility’ was the paramount factor for the TMH group. The PMU group identified several factors, including 'closeness to home', 'ease of access', the 'feel' of the unit and avoidance of ‘unnecessary intervention’ as important. Both groups believed their chosen birthplace was the right and ‘safe’ place for them. Five core themes were identified: the birth process, women’s self-belief in their ability to give birth, midwives, the health system and the birth place. “Confidence” was identified as the overarching concept influencing the themes, and a key enabler for women to plan to give birth in a PMU. Discussion: All of the women had their own midwife. For the PMU group their midwife played an important role in their decision-making. When working in partnership with women, midwives have a role in addressing the underlying beliefs influencing women’s confidence in the birth process, themselves, the health system and birthplaces, which may facilitate midwifery-led unit births.