Choosing an out-of-hospital birth centre: Exploring women's decision-making experiences.
OBJECTIVE
the primary objective for this study was to explore women's experiences of choosing to plan a birth at an out-of-hospital birth centre. We sought to understand how women make the choice to plan for an out-of-hospital birth and the meaning that women ascribe to this decision-making process.


METHODS
a qualitative phenomenological study was conducted in Winnipeg, Canada with a sample of seventeen post partum women who represent the socio-demographic characteristics of the actual users of the Birth Centre in Winnipeg. The women participated in semistructured interviews. Through a feminist perspective and using interpretative phenomenological analysis (IPA), each participant's experience of birthplace decision-making was explored.


RESULTS
six themes emerged through the analysis: (1) Making the decision in the context of relationships; (2) Exercising personal agency; (3) An expression of one's ideology; (4) Really thinking it through; (5) Fitting into the eligibility criteria; and (6) The psychology of the space. The findings suggested that a woman's sense of safety was related to each of these themes.


CONCLUSIONS
the birth centre decision-making experience has many similarities to the homebirth decision-making process. The visceral impact of the physical design of the facility plays an important role and differentiates the birth centre decision from other birth setting options. The concept of relational autonomy was emphasised in this study, in that women make the decision in the context of their relationships with their midwives and partners. The study has implications for midwifery practice and health-care policy related to: client education on birth settings, design of birth environments, validation of the birth centre concept, and upholding the women-centred midwifery model of care. The study highlighted the importance of increasing access to out-of-hospital birth centres.
Midwifery, University College of the North; University of Manitoba, Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, Manitoba, Canada R3T 2N2. Electronic address: rebecca.wood@umanitoba.ca.
Rebecca J
RJ
Wood
Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Human Ecology building, 35 Chancellors Circle, Winnipeg, Manitoba, Canada R3T 2N2. Electronic address: javier.mignone@umanitoba.ca.
Javier
J
Mignone
College of Nursing, Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, Manitoba, Canada R3T 2N2. Electronic address: maureen.heaman@umanitoba.ca.
Maureen I
MI
Heaman
Winnipeg Regional Health Authority, The Birth Centre, 603 St. Mary's Road, Winnipeg, Manitoba, Canada, R2M 3L8. Electronic address: krobinson2@sbgh.mb.ca.
Kristine J
KJ
Robinson
Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Human Ecology building, 35 Chancellors Circle, Winnipeg, Manitoba, Canada R3T 2N2. Electronic address: kerstin.roger@umanitoba.ca.
Kerstin Stieber
KS
Roger
D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards; D016550:Birthing Centers / Q000592:standards*; D002170:Canada; D002755:Choice Behavior; D003657:Decision Making; D005260:Female; D006285:Health Planning / Q000379:methods; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D019472:Universal Health Insurance
Birth centre; Birthplace decision-making; Interpretive phenomenological analysis; Midwifery; Out-of-hospital birth