title: Preferred place of birth: characteristics and motives of low-risk nulliparous women in the Netherlands.
abstract: OBJECTIVE
  to explores preferences, characteristics and motives regarding place of birth of low-risk nulliparous women in the Netherlands.
  
  
  METHODS
  a prospective cohort study of low-risk nulliparous women and their partners starting their pregnancy in midwifery-led care or in obstetric-led care. Data were collected using a self-administered questionnaire, including questions on demographic, psychosocial and pregnancy factors and statements about motives with regard to place of birth. Depression, worry and self-esteem were explored using the Edinburgh Depression Scale (EDS), the Cambridge Worry Scale (CWS) and the Rosenberg Self Esteem Scale (RSE).
  
  
  METHODS
  participants were recruited in 100 independent midwifery practices and 14 hospitals from 2007 to 2011.
  
  
  METHODS
  550 low-risk nulliparous women; 231 women preferred a home birth, 170 women a hospital birth in midwifery-led care and 149 women a birth in obstetric-led care.
  
  
  RESULTS
  Significant differences in characteristics were found in the group who preferred a birth in obstetric-led care compared to the two groups who preferred midwifery-led care. Those women were older (F (2,551)=16.14, p<0.001), had a higher family income (χ(2) (6)=18.87, p=0.004), were more frequently pregnant after assisted reproduction (χ(2)(2)=35.90, p<0.001) and had a higher rate of previous miscarriage (χ(2)(2)=25.96, p<0.001). They also differed significantly on a few emotional aspects: more women in obstetric-led care had symptoms of a major depressive disorder (χ(2)(2)=6.54, p=0.038) and were worried about health issues (F (2,410)=8.90, p<0.001). Women's choice for a home birth is driven by a desire for greater personal autonomy, whereas women's choice for a hospital birth is driven by a desire to feel safe and control risks.
  
  
  CONCLUSIONS
  the characteristics of women who prefer a hospital birth are different than the characteristics of women who prefer a home birth. It appears that for women preferring a hospital birth, the assumed safety of the hospital is more important than type of care provider. This brings up the question whether women are fully aware of the possibilities of maternity care services. Women might need concrete information about the availability and the characteristics of the services within the maternity care system and the risks and benefits associated with either setting, in order to make an informed choice where to give birth.
authors.affiliation: Midwifery Education & Studies Maastricht-ZUYD, Research Department Midwifery Science, PO Box 1256, 6201 BG Maastricht, The Netherlands. t.vanhaaren@av-m.nl
authors.forename: Tamar
authors.initials: T
authors.lastname: van Haaren-Ten Haken
authors.forename: Marijke
authors.initials: M
authors.lastname: Hendrix
authors.forename: Marianne
authors.initials: M
authors.lastname: Nieuwenhuijze
authors.forename: Luc
authors.initials: L
authors.lastname: Budé
authors.forename: Raymond
authors.initials: R
authors.lastname: de Vries
authors.forename: Jan
authors.initials: J
authors.lastname: Nijhuis
mesh_terms: D000328:Adult; D002755:Choice Behavior; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006700:Home Childbirth / Q000523:psychology*; D006801:Humans; D007748:Labor Stage, Second / Q000523:psychology*; D008880:Midwifery / Q000379:methods; D009042:Motivation; D009426:Netherlands; D036801:Parturition / Q000523:psychology*; D057240:Patient Preference / Q000706:statistics & numerical data*; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult