Abstract

In England, most women give birth in hospital obstetric units (OUs). First births usually occur in an OU, and women are thought more likely to opt for a different place of birth in subsequent pregnancies, especially if their first births are straightforward. However, this assumption is not based on evidence, because few studies explore the impact of birth on future birth place intentions.

This NIHR-funded research used a longitudinal, narrative design; 41 women with mixed parity and clinical risk profiles were recruited, using a maximum variation sampling strategy, and 113 interviews were conducted during pregnancy, birth and the early postnatal period. Longitudinal data analysis explored the influence of events during birth upon future birth place intentions.

Planned place of birth, willingness to consider different settings and the timing of birth place decisions all differed by parity. Most women who intended to give birth in hospital did so; following birth, they would usually do the same in future, even if their births were straightforward. Women who planned birth in non-hospital settings were less likely to achieve this, especially during first pregnancies, but usually wanted to achieve non-hospital birth in the future.

These findings raise questions about the effect of birth place decisions made during one pregnancy upon women’s subsequent childbearing careers, and have implications for the sustainability of options other than obstetrician-led units. When balancing risks and benefits of OU birth in one pregnancy, it is important to consider the impact this experience might have on women’s future birth place decisions.