title: Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study.
abstract: OBJECTIVE
  to assess the experiences with maternity care of women who planned birth in a birth centre and to compare them to alternative planned places of birth, by using the responsiveness concept of the World Health Organization.
  
  
  METHODS
  this study is a cross-sectional study using the ReproQ questionnaire filled out eight to ten weeks after birth. The primary outcome was responsiveness of birth care. Secondary outcomes included overall grades for birth care and experiences with the birth centre services. Regression analyses were performed to compare experiences among the planned places of birth. The study is part of the Dutch Birth Centre Study.
  
  
  METHODS
  the women were recruited by 82 midwifery practices in the Netherlands, within the study period 1 August 2013 and 31 December 2013.
  
  
  METHODS
  a total of 2162 women gave written consent to receive the questionnaire and 1181 (54.6%) women completed the questionnaire.
  
  
  RESULTS
  women who planned to give birth at a birth centre: (1) had similar experiences as the women who planned to give birth in a hospital receiving care of a community midwife. (2) had significantly less favourable experiences than the women who planned to give birth at home. Differences during birth were seen on the domains dignity (OR=1.58, 95% CI=1.09-2.27) and autonomy (OR=1.77, 95% CI=1.25-2.51), during the postpartum period on the domains social considerations (OR=1.54, 95% CI=1.06-2.25) and choice and continuity (OR=1.43, 95% CI=1.00-2.03). (3) had significantly better experiences than the women who planned to give birth in a hospital under supervision of an obstetrician. Differences during birth were seen on the domains dignity (OR=0.51, 95% CI=0.31-0.81), autonomy (OR=0.59, 95% CI=0.35-1.00), confidentiality (OR=0.57, 95% CI=0.36-0.92) and social considerations (OR=0.47, 95% CI=0.28-0.79). During the postpartum period differences were seen on the domains dignity (OR=0.61, 95% CI=0.38-0.98), autonomy (OR=0.52, 95% CI=0.31-0.85) and basic amenities (OR=0.52, 95% CI=0.30-0.88). More than 80% of the women who received care in a birth centre rated the facilities, the moment of arrival/departure and the continuity in the birth centre as good.
  
  
  CONCLUSIONS
  in the last decades, many birth centres have been established in different countries, including the United Kingdom, Australia, Sweden and the Netherlands. For women who do not want to give birth at home a birth centre is a good choice: it leads to similar experiences as a planned hospital birth. Emphasis should be placed on ways to improve autonomy and prompt attention for women who plan to give birth in a birth centre as well as on the improvement of care in case of a referral.
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: m.hitzert@erasmusmc.nl.
authors.forename: Marit
authors.initials: M
authors.lastname: Hitzert
authors.affiliation: Department of Child Health, TNO, PO Box 2215, 2316 ZL Leiden, The Netherlands; Department of Obstetrics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands; Midwifery Practice Trivia, Werkmansbeemd 2, 4907 EW Oosterhout, The Netherlands.
authors.forename: Marieke A A
authors.initials: MA
authors.lastname: Hermus
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Marisja
authors.initials: M
authors.lastname: Scheerhagen
authors.affiliation: Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Wisselweg 33, 1314 CB Almere, The Netherlands.
authors.forename: Inge C
authors.initials: IC
authors.lastname: Boesveld
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, The Netherlands.
authors.forename: Therese A
authors.initials: TA
authors.lastname: Wiegers
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: M Elske
authors.initials: ME
authors.lastname: van den Akker-van Marle
authors.affiliation: Department of Life Style, TNO, PO Box 2215, 2316 ZL Leiden, The Netherlands.
authors.forename: Paula
authors.initials: P
authors.lastname: van Dommelen
authors.affiliation: Department of Child Health, TNO, PO Box 2215, 2316 ZL Leiden, The Netherlands.
authors.forename: Karin M
authors.initials: KM
authors.lastname: van der Pal-de Bruin
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Johanna P
authors.initials: JP
authors.lastname: de Graaf
mesh_terms: D000328:Adult; D016550:Birthing Centers / Q000458:organization & administration / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006700:Home Childbirth / Q000592:standards*; D006801:Humans; D008016:Life Change Events; D009426:Netherlands; D010347:Patient Care Planning; D017060:Patient Satisfaction; D011247:Pregnancy; D011795:Surveys and Questionnaires
keywords: Birth centre; Client experiences; Home birth; Obstetric unit; Responsiveness