gms | German Medical Science

Background: There is mounting evidence that home births and midwifery-led births are as safe as giving birth in hospital for low risk women including less medical interventions [1][2]. However the rate of out-of-hospital birth is very low. This raises the question why not more women choose out of hospital birth and if current maternity care actually offers a free choice of place of birth.

Aim: The aim of the study is to find out if women have a free choice of place of birth and to identify the factors influencing that freedom of choice.

Methods: A cross-sectional survey was carried out. This analysis includes data from 292 primi- and multiparae that were assessed by use of an online-questionnaire. Data was analysed employing SPSS statistical program.

Results: Less than half of the women state that they were informed about the different options of place of birth. The chance of getting informed is 2.7 times higher for women who plan an out of hospital birth than it is for women who want to give birth at hospital (OR 0.31 [95% KI 0.15-0.61]; p<0.001). 29.7% of the women state that they were able to make a shared decision with their obstetrician. That applies to significant less women with planned hospital birth (OR 0.48, [95% KI 0.25-0.92]; p<0.05). Every sixth woman states that she was influenced by the opinion of her obstetrician. More than two-thirds of the women never questioned their planned place of birth. About every tenth of the women states that she have had difficulties to find a midwife and about every fifth states financial barriers.

Relevance: Freedom of choice is close related to personal control. It means to have self-determination over the own body and during pregnancy and birth process which in turn correlates with a positive birth experience. The extent of self-determination is influenced by the feeling of being informed and active decision making [3]. Freedom of choice regarding place of birth is a central women‘s right, which is regulated in german law for several times [4][5]. Caregiver and pregnant woman must communicate at eye level and make shared decisions for which both parties can take responsibility.

Conclusions: The generated hypotheses cannot stand the results of the study. There is no (sufficient) shared decision making regarding choice of place of birth so it is not possible for women to make an informed and shared decision, where to give birth. Furthermore the choice of place of birth is limited by a number of external treats. However because of the chosen methods a generalisability of the results cannot be guaranteed. Nevertheless an improvement of maternity care by optimizing the choice options regarding place of birth is needed. In the light of current evidence out-of-hospital birth should be a real option for healthy women with low-risk pregnancies.

Ethical considerations: The participants of the online-questionnaire were informed about the aim of the study and also the fact that the survey is part of a bachelor-thesis and the data is only used for that purpose. To ensure data privacy and the possibility of withdrawing from the study the data was pseudonymised.