Abstract
BackgroundCurrent clinical guidelines and national policy in England support offering ‘low risk’ women a choice of birth setting, but despite an increase in provison of midwifery units in England the vast majority of women still give birth in obstetric units and there is uncertainty around how best to configure services. There is therefore a need to better understand women’s birth place preferences. The aim of this review was to summarise the recent quantitative evidence on UK women’s birth place preferences with a focus on identifying the service attributes that ‘low risk’ women prefer and on identifying which attributes women prioritise when choosing their intended maternity unit or birth setting.MethodsWe searched Medline, Embase, PsycINFO, Science Citation Index, Social Science Index, CINAHL and ASSIA to identify quantitative studies published in scientific journals since 1992 and designed to describe and explore women’s preferences in relation to place of birth. We included experimental stated preference studies, surveys and mixed-methods studies containing relevant quantitative data, where participants were ‘low risk’ or ‘unselected’ groups of women with experience of UK maternity services.ResultsWe included five experimental stated preference studies and four observational surveys, including a total of 4201 respondents. Most studies were old with only three conducted since 2000. Methodological quality was generally poor. The attributes and preferences most commonly explored related to pain relief, continuity of midwife, involvement/availability of medical staff, ‘homely’ environment/atmosphere, decision-making style, distance/travel time and need for transfer. Service attributes that were almost universally valued by women included local services, being attended by a known midwife and a preference for a degree of control and involvement in decision-making. A substantial proportion of women had a strong preference for care in a hospital setting where medical staff are not necessarily involved in their care, but are readily available.ConclusionsThe majority of women appear to value some service attributes while preferences differ for others. Policy makers, commissioners and service providers might usefully consider how to extend the availability of services that most women value while offering a choice of options that enable women to access services that best fit their needs and preferences.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0998-5) contains supplementary material, which is available to authorized users.
Highlights
Current clinical guidelines and national policy in England support offering ‘low risk’ women a choice of birth setting, but despite an increase in provison of midwifery units in England the vast majority of women still give birth in obstetric units and there is uncertainty around how best to configure services
Responsibility for the National Health Service (NHS) is devolved to the four constituent countries, so policies can differ across the United Kingdom (UK)
Sample characteristics: Half (51 %) of the 2071 questionnaires returned were from district general hospitals, 38 % were from university hospitals incorporating midwife-led units and 11 % were from freestanding midwifery unit (FMU)
Summary
Current clinical guidelines and national policy in England support offering ‘low risk’ women a choice of birth setting, but despite an increase in provison of midwifery units in England the vast majority of women still give birth in obstetric units and there is uncertainty around how best to configure services. In 2013, 79 % of women in England lived within a 30 min drive of both an OU and a midwifery unit [7] and more recently a national survey of women’s experiences of maternity care found that 41 % of women were offered a choice of giving birth in a midwivery unit and 18 % were offered the option of a home birth [8]. There is a need for a better understanding of women’s birth place preferences and of the broader factors that influence where women choose to give birth
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