The association of birth model with resilience variables and birth experience: Home versus hospital birth

Midwife-attended planned home births versus planned hospital births in Spain: Maternal and neonatal outcomes

BACKGROUND

The debate on the safety and outcomes of home versus hospital births highlights the need for evidence-based evaluations of these birthing settings, particularly in Catalonia where both options are available.

AIM

To compare sociodemographic characteristics and maternal and neonatal outcomes between low-risk women opting for home versus hospital births in Catalonia, Spain.

METHODS

This observational cross-sectional study analysed 3,463 low-risk births between 2016 and 2018, including 2,713 hospital and 750 home births. Researchers collected sociodemographic data, birthing processes, and outcomes, using statistical analysis to explore differences between the settings.

FINDINGS

Notable differences emerged: Women choosing home births typically had higher education levels and were predominantly Spanish. They were 3.43 times more likely to have a spontaneous birth and significantly less likely to undergo instrumental births than those in hospitals. Home births were associated with higher utilization of non-pharmacological analgesia and a more pronounced tendency to iniciate breastfeeding within the first hour post birth and stronger inclination towards breastfeeding. Hospital births, conversely, showed higher use of the lithotomy position and epidural analgesia. There were no significant differences in neonatal outcomes between the two groups.

CONCLUSIONS AND IMPLICATION FOR PRACTICE

Home births managed by midwives offered better obstetric and neonatal outcomes for low-risk women than hospital births. These results suggest home birth as a safe, viable option that promotes natural birthing processes and reduces medical interventions. The study supports the integration of midwife-led home birth into public health policies, affirming its benefits for maternal and neonatal health.

Exploring home births in Catalonia (Spain): A cross-sectional study of women's experiences and influencing factors

AIM

The study explores the experiences of women with low-risk pregnancies and no complications who planned a home birth.

DESIGN

A cross-sectional study was conducted using an online questionnaire.

METHODS

The questionnaire included socio-demographic, obstetric and perinatal variables. Birth satisfaction was evaluated via the Spanish version of the childbirth experience questionnaire. The study group comprised home-birthing women in Catalonia, Spain. Data were collected from 1 January 2019 to 31 December 2021. Statistical analysis was performed using SPSS.

RESULTS

A total of 236 women responded. They reported generally positive experiences, with professional support and involvement being the most highly rated dimensions. Better childbirth experiences were associated with labour lasting less than 12 h, no perineal injuries, no intrapartum transfers to hospital, euthocic delivery and the presence of a midwife.

CONCLUSIONS

Women's positive home birth experiences were linked to active participation and midwife support. Multiparous women felt safer. Medical interventions, especially transfers to hospitals, reduced satisfaction, highlighting the need for improved care during home births.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Home births should be included among the birthplace options offered by public health services, given the extremely positive feedback reported by women who gave birth at home.

IMPACT

Home birth is not an option offered under Catalonia's public health system only as a private service. The experience of home-birthing women is unknown. This study shows a very positive birth experience due to greater participation and midwife support. The results help stakeholders assess home birth's public health inclusion and understand valued factors, supporting home-birthing women.

REPORTING METHOD

The study followed the STROBE checklist guidelines for cross-sectional studies.

PUBLIC CONTRIBUTION

Women who planned a home birth participated in the pilot test to validate the instrument, and their contributions were collected by the lead researcher. The questionnaire gathered the participants' email addresses, and a commitment was made to disseminate the study's results through this means.

Fear of childbirth and sleep quality among pregnant women: a generalized additive model and moderated mediation analysis

OBJECTIVES

This study aims to examine the associations among fear of childbirth, psychological distress, resilience, and sleep quality among Chinese pregnant women.

METHODS

A cross-sectional survey was carried out between January 2022 to March 2022 among pregnant women who met the inclusion criteria and sought healthcare services at The First Affiliated Hospital of Guangzhou University of Chinese Medicine in Guangdong Province, Southern China. Data was collected using a structured questionnaire that included sociodemographic characteristics, childbirth attitudes questionnaires (CAQ), hospital anxiety and depression scale (HADS), Connor-Davidson resilience scale (CD-RISC), and Pittsburgh sleep quality index (PSQI). A generalized additive model and moderated mediation analysis were employed for data analysis.

RESULTS

A non-linear and negative association between fear of childbirth and sleep quality was found in the second trimester and antenatal period. Psychological distress significantly mediated the relationship between fear of childbirth and sleep quality (first trimester: β = 0.044, 95%CI:0.022-0.071; second trimester: β = 0.029, 95%CI:0.009-0.056; third trimester: β = 0.064, 95%CI:0.046-0.088; antenatal period: β = 0.050, 95%CI:0.037-0.063). The moderating role of resilience between fear of childbirth and sleep quality was significant (second trimester: β=-0.006, 95%CI:-0.012-0.001, P = 0.025; antenatal period: β=-0.004, 95%CI:-0.007--0.001, P = 0.014), as well as between fear of childbirth and psychological distress (first trimester: β=-0.016, 95%CI:-0.026--0.005, P = 0.004; antenatal period: β=-0.005, 95%CI:-0.009--0.001, P = 0.014).

CONCLUSIONS

Fear of childbirth, psychological distress, and resilience are three important factors affecting sleep quality in Chinese pregnant women.

The experience of giving birth: a prospective cohort in a French perinatal network

Background

To assess women's positive and negative perceptions after giving birth. The secondary objectives were to identify the women who had a negative perception of their delivery, define the risk factors, and propose actions that maternity units can take to improve their management.

Methods/design

This study was a multicenter, prospective cohort, conducted in 23 French maternity units constituting one perinatal network, in 2019. All adult women who understood French and gave birth between February 1 and September 27, 2019, were eligible. The exclusion criterion was the woman's objection to participation. Validated self-administered questionnaire (QACE) was sent by email 6 weeks after the child's birth. The main outcome was the experience of childbirth, assessed on a scale of 0 to 10. A good experience was defined by a score ≥ 8/10, and a poor experience by a score < 5. A multinomial logistic regression model, expressed by cumulative proportional odds ratios, were used to determine the factors that might have affected women's experiences during childbirth.

Results

Two thousand one hundred and thirty-fifth women completed the questionnaire, for a participation rate of 49.6%. Overall, 70.7% (n = 1501/2121) of the women reported a good experience, including 38% (n = 807/2121) who graded their experience with the maximum score of 10. On the other hand, 7.3% (n = 156) of the women reported a poor experience. Vaginal delivery (aOR 3.93, 95%CI, 3.04–5.08) and satisfactory management (aOR 11.35 (7.69–16.75)) were the principal determining factors of a positive experience. Epidural analgesia increased the feeling of failure (aOR 5.64, 95%CI, 2.75–13.66). Receiving information and being asked for and agreeing to consent improved the global experience (P = 0.03).

Conclusion

The Identikit picture of the woman associated with a poor experience of childbirth shows a nullipara who had a complication during her pregnancy, gave birth after induction of labor, or by cesarean or operative vaginal delivery, with the newborn transferred for pediatric care, and medical management considered unsatisfactory.

The impacts of the COVID-19 pandemic on birth satisfaction in a prospective cohort of 2,341 U.S. women

PROBLEM

Birth satisfaction is an important health outcome that is related to postpartum mood, infant caretaking, and future pregnancy intention.

BACKGROUND

The COVID-19 pandemic profoundly affected antenatal care and intrapartum practices that may reduce birth satisfaction.

AIM

To investigate the extent to which pandemic-related factors predicted lower birth satisfaction.

METHODS

2341 women who were recruited prenatally in April-May 2020 and reported a live birth between April-October 2020 were included in the current analysis. Hierarchical linear regression to predict birth satisfaction from well-established predictors of birth satisfaction (step 1) and from pandemic-related factors (step 2) was conducted. Additionally, the indirect associations of pandemic-related stress with birth satisfaction were investigated.

FINDINGS

The first step of the regression explained 35% of variance in birth satisfaction. In the second step, pandemic-related factors explained an additional 3% of variance in birth satisfaction. Maternal stress about feeling unprepared for birth due to the pandemic and restrictions on companions during birth independently predicted lower birth satisfaction beyond the non-pandemic variables. Pandemic-related unpreparedness stress was associated with more medicalized birth and greater incongruence with birth preference, thus also indirectly influencing birth satisfaction through a mediation process.

DISCUSSION

Well-established contributors to birth satisfaction remained potent during the pandemic. In addition, maternal stress and restriction on accompaniment to birth were associated with a small but significant reduction in birth satisfaction.

CONCLUSION

Study findings suggest that helping women set flexible and reasonable expectations for birth and allowing at least one intrapartum support person can improve birth satisfaction.

Predictors of Negative Childbirth Experiences Among French Women

OBJECTIVES

To describe the prevalence of negative childbirth experiences and to identify potential predictors, including demographic, prenatal, obstetric, and psychological factors, of these experiences among French women.

DESIGN

Descriptive, correlational, cross-sectional study.

SETTING

A maternity ward in a hospital located near Paris, France.

PARTICIPANTS

A total of 256 women between the ages of 18 and 46 years were recruited while hospitalized in the maternity ward 1 to 6 days after childbirth.

METHODS

Participants completed a personal information form and five self-report scales: the Dyadic Adjustment Scale, the General Self-Efficacy Scale, the State-Trait Anxiety Inventory, the Relationship Scales Questionnaire, and the Questionnaire Assessing the Childbirth Experience. We performed linear regression analyses and used scores on the Questionnaire Assessing the Childbirth Experience as the dependent variable. We considered prenatal, psychological, and obstetric factors as independent variables and adjusted results for covariates.

RESULTS

The prevalence of a negative childbirth experience was 23.3% among our participants. We identified primiparity, high anxiety trait scores, and an anxious attachment style as the prenatal variables that contributed significantly to negative perceptions of childbirth based on the first step of the regression analysis (R² = .18; p < .001). We evaluated objective birth-related variables during the second step and found that mode of birth and use of epidural analgesia were significative predictors of the negative childbirth experience (R² = 0.36; p < .001). The last set of variables included subjective birth-related factors, such as absence of the partner during birth and low perceived sense of control; these variables increased the explained variance from 36% to 69% (p < .001) and showed that these aspects were powerful predictors of a negative childbirth experience.

CONCLUSIONS

Given that some prenatal factors influence women's perceptions of their birth experiences, preventive measures can be implemented by health professionals to support women with risk factors. In the early postpartum period, health care professionals should focus on subjective variables of childbirth because they strongly predict the overall childbirth experience for women.

Associations of rooming-in with maternal postpartum bonding: the impact of mothers' pre-delivery intentions

OBJECTIVE

Full rooming-in, that is, mother and baby staying together for 24 hours per day after birth in the hospital, has been suggested as beneficial for positive maternal bonding. However, it has never been studied directly. We aimed to examine the association of full versus partial rooming-in and maternal bonding to her infant during the post-childbirth hospital stay.

STUDY DESIGN

Longitudinal questionnaire study.

SETTING

Maternity ward of a large tertiary health care center in Israel.

PARTICIPANTS

The sample consisted of postpartum women (N = 293) in a maternity ward of a tertiary health care center who were fully or partially rooming-in.

MEASUREMENTS AND FINDINGS

Questionnaires were administered at two time points, immediately after childbirth (T1; days 1-4) and 2 months postpartum (T2). The Childbirth Experience Questionnaire (CEQ), breastfeeding questions, and the Postpartum Bonding Questionnaire (PBQ) were administered at T1; the PBQ was repeated at T2. Regression analysis revealed that the rooming-in mode did not significantly predict bonding at 1-4 days postpartum. However, the rooming-in mode was a significant predictor of bonding at two months postpartum only for women who practiced the rooming-in mode they had initially planned (Beta = 0.12, p < .05), while controlling for other demographic as well as obstetric variables. Women who chose and practiced partial rooming-in manifested more bonding difficulties than those who chose and practiced full rooming-in. These distinctions in bonding were not manifested when including in the analysis women who partially rooming-in, but not in accordance with their intentions.

CONCLUSIONS

Mother-infant bonding may be optimally supported when women's pre-labor desires to participate in full rooming-in are fulfilled.

IMPLICATIONS FOR PRACTICE

Hospital staff should be aware of the mothers' intentions regarding full rooming-in requests and make sincere efforts to accommodate and support their wishes.

Perinatal Resilience for the First 1,000 Days of Life. Concept Analysis and Delphi Survey

Background

The ability to cope with challenges and stress in life is generally understood as resilience. Pregnancy and parenthood are challenging times. The concept of resilience is receiving increasing interest from researchers, clinicians, and policy staff because of its potential impact on health, well-being, and quality of life. Nevertheless, the concept is less studied during the perinatal period.

Objectives

The aim of this study is to understand the concept of perinatal resilience, including the underlying processes and more specifically for the first 1,000 days of life.

Methods

A concept analysis according to the Walker and Avant (2011) framework was used, to investigate the basic elements of the concept. Concurrently, a two-round Delphi survey involving researchers, clinicians, epidemiologists, mothers, and fathers (N = 21), was conducted to prioritize the terms associated with perinatal resilience. Data collection took place between January and April 2019.

Results

Through concept analysis and Delphi survey, five defining attributes for perinatal resilience were identified: social support, self-efficacy, self-esteem, sense of mastery and personality. The additional terms, rated important by the Delphi survey, were linked to the consequences of being resilient during the perinatal period for the individual and his/her family. Specifically, highlighted were the experiences of families in personal growth and achieving family balance, adaptation, or acceptance.

Conclusion

Based on the results of the concept analysis and Delphi survey, we describe perinatal resilience for the first 1,000 days as a circular process towards a greater well-being in the form of personal growth, family balance, adaptation or acceptance, when faced with stressors, challenges or adversity during the perinatal period. The presence of resiliency attributes such as social support, sense of mastery, self-efficacy, and self-esteem enhance the capacity to be resilient and probably prevent mental health problems.

Women's Choice to Deliver at Home: Understanding the Psychosocial and Cultural Factors Influencing Birthing Choices for Unskilled Home Delivery among Women in Southwestern Uganda

BACKGROUND

Utilization of perinatal services in Uganda remains low, with correspondingly high rates of unskilled home deliveries, which can be life-threatening. We explored psychosocial and cultural factors influencing birthing choices for unskilled home delivery among postpartum women in rural southwestern Uganda.

METHODS

We conducted in-depth qualitative face-to-face interviews with 30 purposively selected women between December 2018 and March 2019 to include adult women who delivered from their homes and health facility within the past three months. Women were recruited from 10 villages within 20 km from a referral hospital. Using the constructs of the Health Utilization Model (HUM), interview topics were developed. Interviews were conducted and digitally recorded in a private setting by a native speaker to elicit choices and experiences during pregnancy and childbirth. Translated transcripts were generated and coded. Coded data were iteratively reviewed and sorted to derive categories using inductive content analytic approach.

RESULTS

Eighteen women (60%) preferred to deliver from home. Women's referent birth location was largely intentional. Overall, the data suggest women choose home delivery (1) because of their financial dependency and expectation for a "natural" and normal childbirth, affecting their ability and need to seek skilled facility delivery; (2) as a means of controlling their own birth processes; (3) out of dissatisfaction with facility-based care; (4) out of strong belief in fate regarding birth outcomes; (5) because they have access to alternative sources of birthing help within their communities, perceived as "affordable," "supportive," and "convenient"; and (6) as a result of existing gender and traditional norms that limit their ability and freedom to make family or health decisions as women.

CONCLUSION

Women's psychosocial and cultural understandings of pregnancy and child birth, their established traditions, birth expectations, and perceptions of control, need, and quality of maternity care at a particular birthing location influenced their past and future decisions to pursue home delivery. Interventions to address barriers to healthcare utilization through a multipronged approach could help to debunk misconceptions, increase perceived need, and motivate women to seek facility delivery.

Predictive factors of women's subjective perception of childbirth experience: a systematic review of the literature

Background: Up to 33% of women report a negative or traumatic childbirth experience. Given this high prevalence and its consistent association with adverse postpartum and child outcomes, it is essential to identify predictive factors and to improve the management of the childbirth experience. Objective: This systematic review explores and identifies risk and protective factors for women's subjective childbirth experience and birth satisfaction by reviewing original research. Methods: A systematic search was performed for childbirth experience literature on three online databases. Reviewed papers focused on women's subjective childbirth experience and its predictive factors. The articles were assessed with the Mixed Methods Appraisal Tool (MMAT). Results: Risk and protective factors are notably different depending on the study design, the country, or the method employed. The main risk factors are obstetric, such as emergency caesarean and highly perceived labour pain, and women's dissatisfaction with social support. The main protective factors are: obstetric, including highly perceived control during labour or satisfaction regarding partner's support. However, overall results are inconclusive for methodological or conceptual reasons. Conclusions: Several risk factors can be identified through pregnancy or childbirth. This underlines the importance of the quality of maternal interpersonal and professional relationships, especially with first-line perinatal health-care professionals, such as midwives.

Measuring women's experiences of decision-making and aspects of midwifery support: a confirmatory factor analysis of the revised Childbirth Experience Questionnaire

BACKGROUND

Women's experiences of labour and birth can have both short- and long-term effects on their physical and psychological health. The original Swedish version of the Childbirth Experience Questionnaire (CEQ) has shown to have good psychometric quality and ability to differentiate between groups known to differ in childbirth experience. Two subscales were revised in order to include new items with more relevant content about decision-making and aspects of midwifery support. The aim of the study was to develop new items in two subscales and to test construct validity and reliability of the revised version of CEQ, called CEQ2.

METHOD

A total of 11 new items (Professional Support and Participation) and 14 original items from the first CEQ (Own capacity and Perceived safety), were answered by 682 women with spontaneous onset of labour. Confirmatory factor analysis was used to analyse model fit.

RESULTS

The hypothesised four-factor model showed good fit (CMIN = 2.79; RMR = 0.33; GFI = 0.94; CFI = 0.94; TLI = 0.93; RMSEA = 0.054 and PCLOSE = 0.12) Cronbach's alpha was good for all subscales (0.82, 0.83, 0.76 and 0.73) and for the total scale (0.91).

CONCLUSIONS

CEQ2, like the first CEQ, yields four important aspects of experience during labour and birth showing good psychometric performance, including decision-making and aspects of midwifery support, in both primiparous and multiparous women.

Being in charge in an encounter with extremes. A survey study on how women experience and work with labour pain in a Nordic home birth setting

PROBLEM

There is a knowledge gap regarding women's experiences of coping with labour pain when not soliciting or not having access to pharmacological pain relief.

BACKGROUND

How women manage labour pain is complex, multifaceted and only the woman giving birth can assess the experienced pain. Women in the Nordic countries planning for a homebirth have little or no access to pharmacologic pain relief during labour.

AIM

The aim of this study was to explore how women experience and work with labour pain when giving birth in their own home.

METHODS

Quantitative and qualitative data was prospectively collected and altogether 1649 women with a planned homebirth answered closed and open-ended questions about labour pain and birth experience.

RESULTS

While labour pain was often experienced as positive or very positive, the intensity was experienced as severe or the worst imaginable pain. Two main themes arose from the womens´ descriptions of their birth experience regarding labour pain: An encounter with extremes and Being in charge at home.

DISCUSSION

Women perceived labour pain as severe but manageable and were dedicated to completing the birth at home. Being at home enabled the women to exercise autonomy and work with labour pain on their own terms, together with the midwife and support persons.

CONCLUSIONS

This study provides knowledge about women's experiences of labour pain in a home birth setting who used varying strategies to work with labour pain. This is a subject that should be explored further since results could also apply to facility-based birth settings.

The correlation between perceived social support and childbirth experience in pregnant women

OBJECTIVE

In recent years, the role of social support on different aspects of health especially pregnancy and childbirth has been emphasized. Social support facilitates individual access to necessary resources during stressful periods of life like pregnancy and childbirth. Present evidence of effects of social support on birth experience is inconsistent, Therefore, this study aimed to determine the correlation between perceived social support in pregnant women and their childbirth experience.

DESIGN

Analytic-cross sectional survey.

SETTING

Al-Zahra maternity hospital in Rasht, Iran.

PARTICIPANTS

185 pregnant women who were in latent phase of labor entered the study and finally, 89.18% (n = 165) completed the study.

MEASUREMENTS

To measure perceived social support, the Multidimensional Scale of Perceived Social Support was used at latent phase of labor and to measure childbirth experience, the Childbirth Experience Questionnaire was used within 2 h after childbirth until the mother was discharged.

RESULTS

Mean score of perceived social support by significant others (4.18 ± 0.79) was higher than other dimensions of social support. Total mean score of childbirth experience was 58.13 ± 10.72 (score range: 22-88). Logistic regression results showed that support by significant others (P = 0.042, OR = 1.56), gestational age (P = 0.003, OR = 1.56) and mode of delivery (P = 0.004, OR = 0.33) are predictor variables of childbirth experience.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Perceived social support by significant others (spouse) during pregnancy has an important effect on woman`s childbirth experience. Therefore, providing training programs for family especially for spouse in order to increase maternal support during pregnancy is recommended, which can lead to a positive childbirth experience.

Between Expectancy and Experience: Testing a Model of Childbirth Satisfaction

Childbirth is a pivotal event for many women, and evidence suggests that women possess strong expectations regarding this experience. In a longitudinal study of 330 Israeli first-time mothers, we distinguished between physical, emotional, and cognitive factors and used them to assess the underlying mechanism of satisfaction, based on theoretical frameworks of stress and control. Women completed questionnaires during pregnancy and two months postpartum. The negative association between a more medicalized birth and birth satisfaction was partially mediated by perceived control. In turn, specific emotions mediated the association between perceived control and satisfaction: Greater perceived control over the birth environment predicted more positive emotions, less fear, and better perceived care; while greater perceived control over the birth process predicted more positive emotions, less fear, and less guilt. Greater incongruence between the planned and actual birth experience predicted lower satisfaction, mediated by perceived care and feelings of guilt. This investigation unraveled the association between women’s lived birth experience and their birth satisfaction. The findings underscore the value of helping women achieve satisfying births by discussing their expectations with them, providing them with experiences that meet their needs, and supporting those with a gap between their expectations and experience. Respecting individual preferences while lowering blame may improve women’s health and well-being. Additional online materials for this article are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/10.1177/0361684318779537 .

First-time mothers' birth beliefs, preferences, and actual birth: A longitudinal observational study

PROBLEM

Birth preferences, such as mode and place of birth and other birth options, have important individual and societal implications, yet few studies have investigated the mechanism which predicts a wide range of childbirth options simultaneously.

BACKGROUND

Basic beliefs about birth as a natural and as a medical process are both predictive factors for childbirth preferences. Studies investigating birth beliefs, preferences, and actual birth are rare.

AIM

To test a predictive model of how these beliefs translate into birth preferences and into actual birth related-options.

METHODS

Longitudinal observational study including 342 first-time expectant mothers recruited at women's health centres and natural birth communities in Israel. All women filled out questionnaires including basic birth beliefs and preferred birth options. Two months postpartum, they filled out a questionnaire including detailed questions regarding actual birth.

FINDINGS

Stronger beliefs about birth being natural were related to preferring a more natural place and mode of birth and preferring more natural birth-related options. Stronger beliefs about birth being medical were associated with opposite options. The preferences mediated the association between the birth beliefs and actual birth. The beliefs predicted the preferences better than they predicted actual birth.

DISCUSSION

Birth beliefs are pivotal in the decision-making process regarding preferred and actual birth options. In a medicalized obstetric system, where natural birth is something women need to actively seek out and insist on, the predictive powers of beliefs and of preferences decrease.

CONCLUSION

Women's beliefs should be recognized and birth preferences respected.

Remote rural women's choice of birthplace and transfer experiences in rural Otago and Southland New Zealand

BACKGROUND

Birth in primary midwife-led maternity units has been demonstrated to be a safe choice for well women anticipating a normal birth. The incidence of serious perinatal outcomes for these women is comparable to similarly low risk women, who choose to birth in hospital. New Zealand women have a choice of Lead Maternity Carer (LMC) and birthplace; home, primary birthing unit, or a base hospital, though not all women may have all these choices available locally. Women in rural and rural remote areas can also choose to birth in their rural primary maternity unit. A percentage of these women (approx. 15-17%) will require transfer during labour, an event which can cause distress and often loss of midwifery continuity of care.

OBJECTIVE

To explore retrospectively the choice of birth place decisions and the labour and birth experiences of a sample of women resident in remotely zoned, rural areas of the lower South Island of New Zealand.

DESIGN

A purposive sample of women living in remote rural areas, recruited by advertising in local newspapers and flyers. Individual semi-structured interviews were digitally recorded using a pragmatic interpretive approach. The data (transcripts and field notes) were analysed using thematic and content analysis. Ethical approval was obtained from the Health and Disability Ethics Committee (HEDC) MEC/06/05/045.

PARTICIPANTS

Thirteen women consented to participate. Each was resident in a remote rural area having given birth in the previous 18 months. The women had been well during their pregnancies and at the onset of labour had anticipated a spontaneous vaginal birth.

SETTING

Rural remote zoned areas in Otago and Southland in the South Island of New Zealand FINDINGS: Five women planned to birth in a regional hospital and eight chose their nearest rural primary maternity unit. All of the women were aware of the possibility of transfer and had made their decision about their birthplace based on their perception of their personal safety, and in consideration of their distance from specialist care. Themes included, deciding about the safest place to give birth; making the decision to transfer; experiencing transfer in labour, and reflecting on their birth experience and considering future birthplace choices.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE AND POLICY

The experiences of the women show that for some, distance from a base hospital influences their place of birth decisions in remote rural areas of New Zealand and increases the distress for those needing to transfer over large distances. These experiences can result in women choosing, or needing to make different choices for subsequent births; the consequences of which impact on the future sustainability of midwifery services in remote rural areas, a challenge which resonates with maternity service provision internationally. While choices about birth place cannot be reliably predicted, creative solutions are needed to provide rural midwifery care and birth options for women and more timely and efficient transfer services when required.