Abstract:
A woman's first birth experience can be a powerfully transformative event in her life, or can
be so traumatic it affects her sense of 'self' for years. It can influence her maternity future,
her physical and emotional health, and her ability to mother her baby. It matters greatly how
her first birth unfolds. Women in Aotearoa/New Zealand enjoy a range of options for provision of maternity care, including, for most, their choice of birth setting. Midwives who practice in a range of settings perceive that birth outcomes for first-time mothers appear to be 'better' at home. An exploration of this perception seems warranted in light of the mainstream view that hospital is the optimal birth setting. The research question was: "Do midwives offer the same intrapartum care at home and in hospital, and if differences exist, how might they be made manifest in the labour and birth events of first-time mothers?" This mixed-methods study compared labour and birth events for two groups of first-time mothers
who were cared for by the same midwives in a continuity of care context. One group of mothers planned to give birth at home and the other group planned to give birth in a hospital where anaesthetic and surgical services were available. Labour and birth event data were collected by a survey which was generated following a focus group discussion with a small group of midwives. This discussion centred around whether these midwives believed their practice differed in each setting, and what influenced care provision in each place. Content analysis of the focus group data saw the emergence of four themes relating to differences in practice: midwives' use of space, their use of time, the 'being' and 'doing' of midwifery and aspects relating to safety. Survey data were analysed using SPSS. Despite being cared for by the same midwives, women in the hospital-birth group were more likely to use
pharmacological methods of pain management, experienced more interventions (ARM, vaginal examinations, IV hydration, active third stage management and electronic foetal monitoring) and achieved spontaneous vaginal birth less often than the women in the homebirth group. These findings strengthen the evidence that for low risk first-time mothers a choice to give birth at home can result in a greater likelihood of achieving a normal birth. The study offers some insights into how the woman's choice of birth place affects the care provided by midwives, and how differences in care provision can relate to differences in
labour and birth event outcomes.
