Birth place preferences and women’s expectations and experiences regarding duration and pain of labor

Abstract

Introduction: We know a great deal about how childbirth is affected by setting; we know less about how the experience of birth is shaped by the attitudes women bring with them to the birthing room. In order to better understand how women frame childbirth, we examined the relationship between birth place preference and expectations and experiences regarding duration of labor and labor pain in healthy nulliparous women.

Methods: A prospective cohort study (2007–2011) of 454 women who preferred a home birth (n = 179), a midwife-led hospital birth (n = 133) or an obstetrician-led hospital birth (n = 142) in the Netherlands. Data were collected using three questionnaires (before 20 weeks gestation, 32 weeks gestation and 6 weeks postpartum) and medical records. Analyses were performed according to the initial preferred place of birth.

Results: Women who preferred a home birth were significantly less likely to be worried about the duration of labor (OR 0.5, 95%CI 0.2–0.9) and were less likely to expect difficulties with coping with pain (OR 0.4, 95%CI 0.2–0.8) compared with women who preferred an obstetrician-led birth. We found no significant differences in postpartum accounts of duration of labor. When compared to women who preferred an obstetrician-led birth, women who preferred a home birth were significantly less likely to experience labor pain as unpleasant (OR 0.3, 95%CI 0.1–0.7). Women who preferred a midwife-led birth – either home or hospital – were more likely to report that it was not possible to make their own choices regarding pain relief compared to women who preferred obstetrician-led care (OR 4.3, 95%CI 1.9–9.8 resp. 3.4, 95%CI 1.5–7.7). Compared to women who preferred a midwife-led hospital birth, women who preferred a home birth had an increased likelihood of being dissatisfied about the management of pain relief (OR 2.5, 95%CI 1.1–6.0).

Discussion: Our findings suggest a more natural orientation toward birth with the acceptance of labor pain as part of giving birth in women with a preference for a home birth. Knowledge about women’s expectations and experiences will help caregivers to prepare women for childbirth and will equip them to advise women on birth settings that fit their cognitive frame.

Keywords:

• Birth experiences
• duration of labor
• expectations
• labor pain
• place of birth

Acknowledgements

We thank the midwifery practices and hospitals for recruiting respondents for our study. We also thank the women who participated in our survey.

Disclosure statement

The authors report no conflicts of interest.

Current knowledge on this subject

• The birth setting has a considerable influence on women’s childbirth experiences.

• Women’s choices for place of birth and caregiver are aligned with their conceptualization of childbirth.

• Most studies of birth experiences in relation to place of birth, used the actual place of birth.

What this study adds

• Women with a preference for a home birth were significantly less worried about duration of labor and coping with pain.

• Most women experienced an intense pain during labor, however, women with a preference for a home birth were less likely to find the experience unpleasant.

• Women with a preference for a home birth had an increased likelihood of being dissatisfied about the management of pain relief during labor.