A Survey of University Students’ Preferences for Midwifery Care and Community Birth Options in 8 High‐Income Countries

Abstract

Introduction: Midwifery care is associated with positive birth outcomes, access to community birth options, and judicious use of interventions. The aim of this study was to characterize and compare maternity care preferences of university students across a range of maternity care systems and to explore whether preferences align with evidence-based recommendations and options available. Methods: A cross-sectional, web-based survey was completed in 2014 and 2015 by a convenience sample of university students in 8 high-income countries across 4 continents (N = 4569). In addition to describing preferences for midwifery care and community birth options across countries, this study examined sociodemographic characteristics, psychological factors, knowledge about pregnancy and birth, and sources of information that shaped students' attitudes toward birth in relation to preferences for midwifery care and community birth options. Results: Approximately half of the student respondents (48.2%) preferred midwifery-led care for a healthy pregnancy; 9.5% would choose to give birth in a birthing center, and 4.5% preferred a home birth. Preference for midwifery care varied from 10.3% among women in the United States to 78.6% among women in the United Kingdom. Preferences for home birth varied from 0.3% among US women to 18.3% among Canadian women. Women, health science students, those with low childbirth fear, those who learned about pregnancy and birth from friends (compared with other sources, eg, the media), and those who responded from Europe were significantly more likely to prefer midwifery care and community birth. High confidence in knowledge of pregnancy and birth was linked to significantly higher odds of community birth preferences and midwifery care preferences. Discussion: It would be beneficial to integrate childbirth education into high school curricula to promote knowledge of midwifery care, pregnancy, and childbirth and to reduce fear among prospective parents. Community birth options need to be expanded to meet demand among the next generation of maternity service users.

Factors influencing birth setting decision making in the United States: An integrative review

“…An additional 10 studies included participants currently pregnant, of which four studies included participants anticipating their first births 39,41,45,56 and five studies included participants anticipating their first or subsequent births 46,47,49,50,52,55 . Six studies also included participants who did not report a pregnancy or birth history 17,40,42,46,53,54 …”

“…In contrast, participants in seven studies highlighted perceived risks of home birth as a major reason they would only consider a hospital birth. 17,39,41,[44][45][46]57 For participants who chose a hospital setting, they believed hospitals to be the safest place to give birth. Other common reasons for participants to choose hospital birth included the perception that birth is an inherently risky event requiring the attendance of a doctor and the belief that their bodies need help to birth their babies.…”

“…32 Limited choice and access to unbiased information about the risks and benefits of different birth locations contribute to the underutilization of low-intervention birth settings, particularly options for birth center and home births. [15][16][17] Only an estimated 1.99% of the 3.61 million annual births occur in birth center and home settings. 18 However, there is growing interest in birth center and home birth, 14,19 with researchers reporting that the COVID-19 pandemic has accelerated this trend.…”

Screening for Perinatal Anxiety Using the Childbirth Fear Questionnaire: A New Measure of Fear of Childbirth

“…Given the dimensional latent structure of fear of childbirth, it will be important to bear in mind that any cut-off score will be arbitrary and result in a loss of information. It is thus better for future studies to keep the full continuum of scores and respect the dimensional latent structure of the data [ 90 ].…”

Choosing a Birth Setting: A Shared Decision‐Making Approach

“…33,34 In addition, there are 1095 counties that are referred to as maternity care deserts, or areas in which there are extremely limited or no birth facilities or providers. 35 Additional barriers to shared decision-making about birth settings include health care provider biases about birth center and home birth, [36][37][38] media bias and lack of knowledge about such options among the public, 39,40 and financial profits linked to patient numbers and cesarean birth. 41…”