title: Birth centres and the national maternity services review: response to consumer demand or compromise?
abstract: BACKGROUND
  In February 2009 the Improving Maternity Services in Australia - The Report of the Maternity Services Review (MSR) was released and recommended improving women's access to and availability of birth centres. It was unclear if this was in response to an overwhelming request for birth centres in the submissions received by the commonwealth or a compromise for excluding homebirth from the maternity service reforms.
  
  
  OBJECTIVE
  The aim of this paper was to examine what was said in the submissions to the MSR about birth centres.
  
  
  METHODS
  Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Ageing website. All 832 submissions were downloaded, and read for any mention of the words 'birth centre', 'birth center'. Content analysis was used to categorise and report the data.
  
  
  RESULTS
  Of the 832 submissions to the MSR 197 (24%) mentioned birth centres while 470 (60%) of the submissions mentioned homebirth. Only 31 (4%) of the submissions to the Maternity Review mentioned birth centres without mentioning home birth also. Most of the submissions emphasised that 'everything should be on the menu' when it came to place of birth and care provider. Reasons for choosing a birth centre were identified as: 'the best compromise available, 'the right and natural way' and 'the birth centre as safe'. Women had certain requirements of a birth centre that included: 'continuity of carer', 'midwife led', 'a sanctum from medicalised care', 'resources to cope with demand', 'close to home', and 'flexible guidelines and admission criteria'. Women weighed up a series of requirements when deciding whether to give birth in a birth centre.
  
  
  CONCLUSIONS
  The recommendation by the MSR to expand birth centres and ignore home birth is at odds with the strong view expressed that 'everything should be on the menu'. The requirements women described of birth centre care are also at odds with current trends.
  
  
  CONCLUSIONS
  If there is to be an expansion of birth centres, service providers need to make sure that women's views are central to the design. Women will not cease having homebirths due to expanded birth centre options.
authors.affiliation: School of Nursing and Midwifery, College of Health and Science, University of Western Sydney, Building ER, Parramatta Campus, Locked Bag 1797, Penrith South DC, NSW 1797, Australia. h.dahlen@uws.edu.au
authors.forename: H
authors.initials: H
authors.lastname: Dahlen
authors.forename: M
authors.initials: M
authors.lastname: Jackson
authors.forename: V
authors.initials: V
authors.lastname: Schmied
authors.forename: S
authors.initials: S
authors.lastname: Tracy
authors.forename: H
authors.initials: H
authors.lastname: Priddis
mesh_terms: D001315:Australia; D016550:Birthing Centers; D003266:Continuity of Patient Care; D005069:Evaluation Studies as Topic; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility; D006700:Home Childbirth; D006801:Humans; D008427:Maternal Health Services; D008880:Midwifery; D011247:Pregnancy; D058028:Research Report