Abstract
BackgroundIn several developed countries women with a low risk of complications during pregnancy and childbirth can make choices regarding place of birth. In the Netherlands, these women receive midwife-led care and can choose between a home or hospital birth. The declining rate of midwife-led home births alongside the recent debate on safety of home births in the Netherlands, however, suggest an association of choice of birth place with psychological factors related to safety and risk perception. In this study associations of pregnancy related anxiety and general anxious or depressed mood with (changes in) planned place of birth were explored in low risk women in midwife-led care until the start of labour.MethodsData (n = 2854 low risk women in midwife-led care at the onset of labour) were selected from the prospective multicenter DELIVER study. Women completed the Pregnancy Related Anxiety Questionnaire-Revised (PRAQ-R) to assess pregnancy related anxiety and the EuroQol-6D (EQ-6D) for an anxious and/or depressed mood.ResultsA high PRAQ-R score was associated with planned hospital birth in nulliparous (aOR 1.92; 95% CI 1.32–2.81) and parous women (aOR 2.08; 95% CI 1.55–2.80). An anxious or depressed mood was associated with planned hospital birth (aOR 1.58; 95% CI 1.20–2.08) and with being undecided (aOR 1.99; 95% CI 1.23–2.99) in parous women only. The majority of women did not change their planned place of birth. Changing from an initially planned home birth to a hospital birth later in pregnancy was, however, associated with becoming anxious or depressed after 35 weeks gestation in nulliparous women (aOR 4.17; 95% CI 1.35–12.89) and with pregnancy related anxiety at 20 weeks gestation in parous women (aOR 3.91; 95% CI 1.32–11.61).ConclusionLow risk women who planned hospital birth (or who were undecided) more often reported pregnancy related anxiety or an anxious or depressed mood. Women who changed from home to hospital birth during pregnancy more often reported pregnancy related anxiety or an anxious or depressed mood in late pregnancy. Anxiety should be adequately addressed in the process of informed decision-making regarding planned place of birth in low risk women.
Highlights
In several developed countries women with a low risk of complications during pregnancy and childbirth can make choices regarding place of birth
We examined whether the association between anxiety and planned place of birth changed when these factors were entered in the regression model
Background characteristics of low risk women in midwife-led care that were excluded because of incomplete or missing data on questionnaire 2 (n = 1,251; Fig. 1) differed significantly (p < .05) from those included in the analyses (n = 1603) in ethnicity (i.e. 9.8% vs. 4.5% of non-Dutch origin, respectively), Socioeconomic status (SES), and age (i.e. < 25, 13.9% vs. 7%; 25– 34, 69.1% vs. 73.9%; > 35; 17% vs. 19.1%, respectively)
Summary
In several developed countries women with a low risk of complications during pregnancy and childbirth can make choices regarding place of birth. The highest rates of home birth can still be found in the Netherlands, the Dutch home birth rate has significantly declined as well from 32% between 2001 and 2003 to 21% between 2010 and 2012 [5] This decline may be associated with the growing demand of medical pain relief which is only available in obstetrician-led care [6, 7] and with a change in policies regarding maternal risk factors such as high BMI leading to more women identified as having a medium- or high risk profile [8]. This information is important for women in terms of informed decision-making regarding place of birth and other intrapartum care choices such as the possibility of pain-relief [22], as well as in terms of their psychological wellbeing such as an increased risk of potentially distressing obstetric interventions depending on their planned place of birth [23]
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