Can childbirth be changed? — offering women a choice

Abstract

This article discusses the implementation and evaluation of an initiative to routinely provide healthy women with five choices for the type of maternity care they receive (community- and hospital-based shared care, named midwife care, DOMINO and home birth). A cohort study of 345 women was carried out at the Glasgow Royal Maternity Hospital. The study aimed to: determine the proportion of women offered choice for their type of maternity care after the introduction of the initiative; determine the proportion of women choosing the different types of care and to examine the socio-demographic predictors of the choice of care; and examine women's attitudes to being offered a choice in the type of maternity care they receive and reasons for making particular choices. The study was carried out using a retrospective review of case records and self-report questionnaires from a consecutive sub-sample of 170 women. Of those eligible, 90% (95% CI: 86% to 93%) were offered choice of care type. Half of the eligible women chose community-based shared care, 36% chose named midwife care, 10% chose hospital-based shared care, 4% requested DOMINO care and less than 1% selected home birth. Women's choice of the type of care they received was unrelated to their socio-demographic characteristics. Women were satisfied with the way that choices were offered and valued being able to choose their type of care. The response rate of the questionnaire was 84%. This article concludes that it may be realistic to routinely offer women a variety of choices of the care type they receive given the support of the professional groups involved.