Choosing childbirth provider location - rural women's perspective

Abstract

The delivery of obstetric services in rural communities is under threat. Decreased choice in services can result in women being forced to seek obstetric care outside their own local community, possibly contrary to their preference. Other women willingly make the decision to travel away to deliver. We investigated factors that influenced rural women's choice of childbirth provider location. Roma, a provincial centre approximately 490 km west of Brisbane, Queensland, Australia has a population of approximately 15 000 living in the town or surrounding areas. It has a public hospital with maternity unit, supported by a paediatrician and flying obstetrician. We did an exploratory study, conducting semi-structured interviews with 20 women who lived in Roma (or surrounds) and had delivered a baby between January 2001 and August 2004, or were pregnant when interviewed. Themes were extracted from transcripts of audiotapes and field notes and analysed using an appropriate framework. A subset of interviews were reviewed by both authors and themes compared. Fourteen women (70%) delivered locally and six (30%) travelled away, comparable with Queensland perinatal data for 1995 to 2003. The women reported a range of reasons that influenced their choice of childbirth provider location. All participants stated that concerns about the safety of themselves and, more importantly, their baby influenced their choice. The availability of family support and familiarity with the doctor and maternity service influenced choice, as did financial considerations. All participants agreed that delivering in town was logistically much easier, however some choose to deliver away. Different women were influenced by a different set of factors; however, safety (actual and perceived) appeared to be the overriding concern of all participants. This study highlights the pivotal importance of perceived safety on women's decision-making about where to deliver their babies. Measures to increase the number of deliveries in rural towns to prevent further withdrawal of obstetric services must address actual and perceived safety issues to be successful.