Choosing place of birth in the Netherlands: a qualitative study on women's beliefs, expectations and preferences

Background: in the Netherlands, healthy women with a physiological pregnancy are offered the choice of home or hospital birth. Women’s attitudes toward birth determine their expectations and fears and form the foundation of... [ view full abstract ]

Background: in the Netherlands, healthy women with a physiological pregnancy are offered the choice of home or hospital birth. Women’s attitudes toward birth determine their expectations and fears and form the foundation of their choices. Attitudes are shaped by knowledge, experiences, beliefs, cultural ideas, and hopes. Given the lack of insight into women’s attitudes, we designed a study to gain a further understanding of how women’s attitudes influence their choice for place of birth. 

Method: a qualitative, descriptive design using semi-structured interviews. Twenty three healthy nulliparous women in their third trimester of pregnancy were recruited in 2015. Data were analysed using a modified form of framework analysis. 

Results: three main themes were identified: (i) beliefs – conceptions about birth, risk and care; (ii) expectations – approaching the unknown; and (iii) choice – preference not insistence. 

Discussion: Safety played an important role in the choice of birth place: women who chose hospital birth wanted to be safe, while women who chose home birth wanted to feel safe. Despite women’s view that birth is a natural and normal part of life, most women accepted the fact that they might need some kind of pain relief or intervention during birth. The unknown nature of childbirth made them feel that they needed to be flexible, resulting in a pragmatic ‘take it as it comes’ attitude without having too many expectations or demands. Generally, women’s birth place decisions were not highly polarised between either home or hospital birth. As a result, women who chose birth at home saw it as a preference not a demand.    

Conclusion: women expressed no clear expectations and were flexible in their attitudes towards place of birth and the possible need for interventions. It is important to talk with each woman about her expectations, knowledge, and risk perception to enable her to make an informed and motivated choice for place of birth. Considering the increasing number of non-urgent referrals during birth and the decreasing number of home births in the Netherlands, midwives need to focus on their role of promoting trust in normal birth, balancing considerations of risk with the principle of women-centred care.