Background Findings from the NPEU Birthplace study suggest that women with straightforward pregnancies should have increased access to midwifery units and the RCOG response has raised questions about the right birth location for first time mothers. Women with straightforward pregnancies are more likely to have a normal birth in midwifery units, yet most still give birth on obstetric units.

Methods This NIHR-funded adjunct study to the NPEU research was designed to investigate how women and their partners make decisions about where to give birth. Preference for non-hospital settings was explored alongside preference for hospital birth and medical care. The study used a longitudinal prospective qualitative design and recruited 41 women with mixed parity and 15 partners from three NHS trusts, each of which provided different ‘birth place’ options.

Findings Women with straightforward pregnancies often preferred to give birth in obstetric units believing hospital birth to be safer; giving birth in midwife units was valued by some but thought to be unnecessarily risky by others. The ways in which different settings were presented by clinicians during antenatal care influenced women's birth place preferences.

Discussion Women's birth place decisions are currently hampered by limited availability of information and by a tendency on the part of clinicians, including midwives, towards presuming that birth will take place in an obstetric unit. Increased uptake of birth in midwifery units depends on balanced provision of evidence- based information about the risks and benefits of different birth settings, contextualised to individual pregnancies.