title: An exploration of influences on women's birthplace decision-making in New Zealand: a mixed methods prospective cohort within the Evaluating Maternity Units study.
abstract: BACKGROUND
  There is worldwide debate surrounding the safety and appropriateness of different birthplaces for well women. One of the primary objectives of the Evaluating Maternity Units prospective cohort study was to compare the clinical outcomes for well women, intending to give birth in either an obstetric-led tertiary hospital or a free-standing midwifery-led primary maternity unit. This paper addresses a secondary aim of the study--to describe and explore the influences on women's birthplace decision-making in New Zealand, which has a publicly funded, midwifery-led continuity of care maternity system.
  
  
  METHODS
  This mixed method study utilised data from the six week postpartum survey and focus groups undertaken in the Christchurch area in New Zealand (2010-2012). Christchurch has a tertiary hospital and four primary maternity units. The survey was completed by 82% of the 702 study participants, who were well, pregnant women booked to give birth in one of these places. All women received midwifery-led continuity of care, regardless of their intended or actual birthplace.
  
  
  RESULTS
  Almost all the respondents perceived themselves as the main birthplace decision-makers. Accessing a 'specialist facility' was the most important factor for the tertiary hospital group. The primary unit group identified several factors, including 'closeness to home', 'ease of access', the 'atmosphere' of the unit and avoidance of 'unnecessary intervention' as important. Both groups believed their chosen birthplace was the right and 'safe' place for them. The concept of 'safety' was integral and based on the participants' differing perception of safety in childbirth.
  
  
  CONCLUSIONS
  Birthplace is a profoundly important aspect of women's experience of childbirth. This is the first published study reporting New Zealand women's perspectives on their birthplace decision-making. The groups' responses expressed different ideologies about childbirth. The tertiary hospital group identified with the 'medical model' of birth, and the primary unit group identified with the 'midwifery model' of birth. Research evidence affirming the 'clinical safety' of primary units addresses only one aspect of the beliefs influencing women's birthplace decision-making. In order for more women to give birth at a primary unit other aspects of women's beliefs need addressing, and much wider socio-political change is required.
authors.affiliation: Midwifery and Women's Health Research Unit, Faculty of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia. celia.grigg@sydney.edu.au.
authors.forename: Celia
authors.initials: C
authors.lastname: Grigg
authors.forename: Sally K
authors.initials: SK
authors.lastname: Tracy
authors.forename: Rea
authors.initials: R
authors.lastname: Daellenbach
authors.forename: Mary
authors.initials: M
authors.lastname: Kensington
authors.forename: Virginia
authors.initials: V
authors.lastname: Schmied
mesh_terms: D000328:Adult; D016550:Birthing Centers; D003266:Continuity of Patient Care; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006771:Hospitals, Maternity; D006801:Humans; D008880:Midwifery / Q000458:organization & administration*; D009520:New Zealand; D010347:Patient Care Planning; D011247:Pregnancy; D011295:Prenatal Care; D011446:Prospective Studies; D012449:Safety; D062606:Tertiary Care Centers; D055815:Young Adult