Abstract
The choice of birthplace may have an important impact on a woman’s health. In this longitudinal study, we investigated the psychopathological risk factors that drive women’s choice of birthplace, since their influence is currently not well understood. The research was conducted in 2011/12 and we analyzed data of 177 women (obstetric unit, n = 121; free standing midwifery unit, n = 42; homebirth, n = 14). We focused antepartally (M = 34.3 ± 3.3) on sociodemographic and risk factors of psychopathology, such as prenatal distress (Prenatal Distress Questionnaire), depressiveness (Edinburgh Postnatal Depression Scale), birth anxiety (Birth Anxiety Scale), childhood trauma (Childhood Trauma Questionnaire), and postpartally (M = 6.65 ± 2.6) on birth experience (Salmon’s Item List), as well as psychological adaption, such as postpartum depressive symptoms (Edinburgh Postnatal Depression Scale) and birth anxiety felt during birth (modified Birth Anxiety Scale). Women with fear of childbirth and the beginning of birth were likely to plan a hospital birth. In contrast, women with fear of touching and palpation by doctors and midwives, as well as women with childhood trauma, were more likely to plan an out-of-hospital birth. Furthermore, women with planned out-of-hospital births experienced a greater relief of their birth anxiety during the birth process than women with planned hospital birth. Our results especially show that women with previous mental illnesses, as well as traumatic experiences, seem to have special needs during childbirth, such as a safe environment and supportive care.
Highlights
Current international guidelines emphasize the importance for low-risk women to have a choice for their intended birthplace
Our study demonstrated that psychopathological risk factors and traumatic experiences had an impact on the decision-making process of pregnant women for their choice of birthplace
We showed that factors such as birth anxiety and prenatal distress influenced the choice of birthplace, and that women with early traumatic experiences were significantly more likely to choose an out-of-hospital birth
Summary
Current international guidelines emphasize the importance for low-risk women to have a choice for their intended birthplace. In Germany, women with low-risk pregnancies may choose any birth setting, including hospital obstetric units (OU), free-standing midwifery units (FMU) or at home (homebirth; HB). The significantly higher technical safety in hospital obstetric units, contrasts higher satisfaction levels and a more positive birth experience in women with out-of-hospital births, which has important long-term implications for a mother’s health and emotional wellbeing [6,7,8,9]. Based on our results on the higher proportion of multiparous women in the out-of-hospital groups, we assume previous birth experiences to have a decisive influence on birthplace choice. In contrast to previous studies, we could not confirm an association between a higher level of education and out-of-hospital birth [32,33,34]. It can be assumed that the out-of-hospital women represented a more family-oriented lifestyle, and that their decision to stay at home was made consciously
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