Experience of childbirth in birth center care. A randomized controlled study.
BACKGROUND
The objective of the study was to compare women's use of obstetric analgesia, experience of pain in labor, and other aspects of the childbirth experience at an in-hospital birth center and with standard maternity care. The birth center care was characterized by comprehensive antenatal, intrapartum and post partum care, on the same premises with a home-like environment and the same team of midwives, restricted use of medical technology and pharmacological pain relief, and discharge within 24 h after birth.


METHODS
Of 1,230 women interested in birth center care and meeting low-risk medical criteria in early pregnancy, 617 were randomly allotted birth center care (EG) and 613 standard obstetric care (CG). Data were collected by questionnaires two months post partum, and hospital records.


RESULTS
EG women used less pharmacological pain relief than CG women, but no difference was observed concerning the retrospective attitude to pain, or among primiparas, to the intensity of pain experienced. EG multiparas experienced pain in labor as more intense, than did CG multiparas, probably because of a more negative prenatal attitude to labor pain. EG women experienced more support from the midwife, and a greater freedom in expressing their feelings during the birth than CG women. EG primiparas were more satisfied with their own achievement and felt more involved in the birth process than CG primiparas. No differences were observed between the groups regarding overall experience of childbirth, anxiety during the birth or support from husband.


CONCLUSIONS
Birth center care gave women interested in a natural childbirth, by avoiding pharmacological pain relief, greater opportunity to give birth according to their prenatal wishes, and it contributed to a slightly more positive birth experience.
Waldenström
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Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
Nilsson
C A
CA
D000328:Adult; D016362:Analgesia, Obstetrical; D000700:Analgesics / Q000008:administration & dosage; D016550:Birthing Centers; D003625:Data Collection; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008427:Maternal Health Services / Q000592:standards*; D008429:Maternal Welfare; D008499:Medical Records; D009321:Natural Childbirth; D010146:Pain / Q000188:drug therapy; D010298:Parity; D011181:Postnatal Care; D011247:Pregnancy; D011295:Prenatal Care; D011795:Surveys and Questionnaires; D013548:Sweden
D000700:Analgesics