Mar. 14, 2013 Women who see themselves as active participants in the delivery of their first child, and prefer a collaborative role with their healthcare provider are more likely to prefer planned home birth and the care of a midwife, according to a new survey conducted by Columbia University School of Nursing's Adriana Arcia, PhD, RN, and published in the journal Midwifery.
Alternatively, when women perceive the mother's role in the birthing process more passively, and are more fearful of the of the delivery experience, they are more likely to seek the care of a physician and the hospital setting for childbirth.
A web-based survey of perceptions toward childbirth by women of child-bearing years (ages 18 -40) that have not yet had children was designed to better understand respondents' perceptions of three areas: the Mother's Role, the Provider's Role, and the Delivery Experience. Their answers indicated whether they perceived the Mother's Role as active or passive, the Provider's Role as dominant or collaborative, and the Delivery Experience as fearful and painful, or as a positive occurrence.
"We found women who perceived their role in the birth of their first child as an active one, the provider's role as collaborative, and the delivery of the child as a positive experience, were more likely to prefer midwifery care, birth at home, a vaginal delivery and the avoidance of pain medication," said Arcia.
However, the number of "passive" moms far outnumbered the number of "active" moms. These women preferred a physician to attend their delivery, to give birth in a hospital setting, and also preferred vaginal delivery.
"However, the more painful and fearful expects the delivery experience to be, the more likely she is to prefer a caesarean delivery to vaginal birth," said Arcia. Caesarean rates in the United States are more than double the upper threshold recommended by the World Health Organization, and at those levels are associated with increased maternal morbidity and mortality, neonatal morbidity and mortality, and increased financial burden to the healthcare system. Alternatively, midwifery care consistently has been found to be as safe and effective as traditional obstetric care and is associated with lower rates of obstetric interventions, including caesarean births.
"Since we know that a woman's perception of her role in the delivery of her child can influence her birth preferences," said Arcia. "As women become more aware of their options and wish to place the locus of control closer to them, more women will regard midwifery care and planned home birth as an attractive option."
The survey, U.S. Nulliparas' Perceptions of Roles and of the Birth Experience as Predictors of Their Delivery Preferences," also reported that 99.4 percent of respondents used the Internet to seek out information related to pregnancy and delivery.
"Because many women are turning to the Internet for information, midwives and other birth care providers have a responsibility to have a working knowledge of the pregnancy and delivery information that can be found online," said Arcia. "A more proactive approach would be for providers to involve themselves in developing online resources to ensure that what women are reading online is factual and evidence-based."
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- Adriana Arcia. US nulliparas' perceptions of roles and of the birth experience as predictors of their delivery preferences. Midwifery, 2013; DOI: 10.1016/j.midw.2012.10.002
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