title: Variation in home-birth rates between midwifery practices in The Netherlands.
abstract: OBJECTIVE
  To examine the reasons for the variation in home-birth rates between midwifery practices.
  
  
  METHODS
  Multi-level analysis of client and midwife associated, case-specific and structural factors in relation to 4420 planned and actual home or hospital births in 42 midwifery practices.
  
  
  RESULTS
  Women's choice of birth location and the occurrence of complications that lead to referral to specialist care before or during labour, were found to be the main determinants of the home-birth rate. Yet, about 64% of the variation between midwifery practices is explained by midwife and practice characteristics. Higher home-birth rates were associated with a positive attitude to home-birth, a critical attitude to hospital birth for non-medical reasons, and good co-operation between midwifery practices and hospital obstetricians.
  
  
  CONCLUSIONS
  The proportions of planned hospital birth and of referral to specialist care are the most important predictors of the actual hospital-birth rate of women receiving midwifery care. Both can be influenced by the midwife through a positive attitude to home-birth, a critical approach to non-medical reasons for hospital birth, and good co-operation with specialist obstetricians. It is, therefore, important for midwives to be aware of the influence that their own attitudes may have on the choices their clients make about home or hospital birth.
authors.affiliation: NIVEL (Netherlands Institute of Primary Health Care), PO Box 1568, 3500 BN Utrecht, The Netherlands.
authors.forename: T A
authors.initials: TA
authors.lastname: Wiegers
authors.forename: J
authors.initials: J
authors.lastname: van der Zee
authors.forename: J J
authors.initials: JJ
authors.lastname: Kerssens
authors.forename: M J
authors.initials: MJ
authors.lastname: Keirse
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008880:Midwifery / Q000706:statistics & numerical data*; D009426:Netherlands; D011247:Pregnancy; D011331:Private Practice / Q000706:statistics & numerical data; D011364:Professional Practice / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data