Birth setting, transfer and maternal sense of control: results from the DELIVER study.
BACKGROUND
In the Netherlands, low risk women receive midwife-led care and can choose to give birth at home or in hospital. There is concern that transfer of care during labour from midwife-led care to an obstetrician-led unit leads to negative birth experiences, in particular among those with planned home birth. In this study we compared sense of control, which is a major attribute of the childbirth experience, for women planning home compared to women planning hospital birth under midwife-led care. In particular, we studied sense of control among women who were transferred to obstetric-led care during labour according to planned place of birth: home versus hospital.


METHODS
We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Sense of control during labour was assessed 6 weeks after birth, using the short version of the Labour Agentry Scale (LAS-11). A higher LAS-11 score indicates a higher feeling of control. We considered a difference of a minimum of 5.5 points as clinically relevant.


RESULTS
Nulliparous- and parous women who planned a home birth had a 2.6 (95% CI 1.0, 4.3) and a 3.0 (1.6, 4.4) higher LAS score during first stage of labour respectively and during second stage a higher score of 2.8 (0.9, 4.7) and 2.3 (0.6, 4.0), compared with women who planned a hospital birth. Overall, women who were transferred experienced a lower sense of control than women who were not transferred. Parous women who planned a home birth and who were transferred had a 4.3 (0.2, 8.4) higher LAS score in 2nd stage, compared to those who planned a hospital birth and who were transferred.


CONCLUSIONS
We found no clinically relevant differences in feelings of control among women who planned a home or hospital birth. Transfer of care during labour lowered feelings of control, but feelings of control were similar for transferred women who planned a home or hospital birth.As far as their expected sense of control is concerned, low risk women should be encouraged to give birth at the location of their preference.
Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, the Netherlands. c.geerts@vumc.nl.
Caroline C
CC
Geerts
Trudy
T
Klomp
Antoine L M
AL
Lagro-Janssen
Jos W R
JW
Twisk
Jeroen
J
van Dillen
Ank
A
de Jonge
D000328:Adult; D036861:Delivery, Obstetric / Q000523:psychology; D005260:Female; D006700:Home Childbirth; D006801:Humans; D007389:Internal-External Control; D007747:Labor Stage, First / Q000523:psychology; D007748:Labor Stage, Second / Q000523:psychology; D008880:Midwifery; D009426:Netherlands; D007744:Obstetric Labor Complications / Q000523:psychology* / Q000628:therapy*; D009774:Obstetrics; D010298:Parity; D010347:Patient Care Planning; D010360:Patient Transfer; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult