Does a Pregnant Woman's Intended Place of Birth Influence Her Attitudes Toward and Occurrence of Obstetric Interventions?


  • Leonie A.M. Van Der Hulst MA, Midwife,

    Corresponding authorSearch for more papers by this author
  • Edwin R. Van Teijlingen PhD, MEd, MA(Hons),

  • Gouke J. Bonsel MD, PhD,

  • Martine Eskes MD, PhD,

  • Otto P. Bleker MD, PhD, FRCOG

  • Leonie van der Hulst is midwife-researcher and sociologist, Otto Bleker is professor of obstetrics and gynecology, Department of Obstetrics and Gynecology, and Gouke Bonsel is professor of public health methods, Department of Social Medicine, at the Academic Medical Centre, University of Amsterdam, The Netherlands; Edwin van Teijlingen is senior lecturer in the Department of Public Health/Dugald Baird Centre for Research on Women's Health at the University of Aberdeen, Scotland, United Kingdom; and Martine Eskes is medical advisor at the National Health Insurance Board (CvZ), Diemen, The Netherlands.

  • This study was funded by ZON-MW (formerly ‘Prevention Fund’), The Hague, The Netherlands (grant number: 28–2898).

*Leonie A.M. van der Hulst, midwife, MA, Department of Obstetrics and Gynecology H4–210, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.


Abstract: Background: A home confinement with midwifery care is still an integral part of Dutch maternity care. It has been argued that the existence of home birth itself influences the course of the birth process positively, which is why obstetric interventions are low in comparison with neighboring countries. This study examined the impact of women's intended place of birth (home or hospital) and the course of pregnancy and labor when attended by midwives. Methods: This is a prospective study of 625 low-risk pregnant women, gestation 20 to 24 weeks, enrolled in 25 independently working midwifery practices. The course of labor was measured by the frequency of interventions by midwives and obstetricians. Results: Amore nontechnological approach to childbirth was observed within the women opting for a home birth compared with the women opting for a hospital birth. Data showed a relationship between interventions and planned birth site: sweeping membranes and amniotomy by midwives were more likely to be conducted in women opting for a home birth. Multiparas opting for hospital birth were more likely to experience consultations and referrals. Within the group of multiparas referred for obstetrician care, women intending to have a home birth experienced fewer interventions (e.g., induction, augmentation, pharmacologic pain relief, assisted delivery, cesarean section) compared with those who had opted for a hospital birth. Conclusions: A large proportion of women desire a home birth. The impact of that choice demonstrated a smoother course of the birth process, compared with women who desired to deliver in the hospital, as measured by fewer obstetric interventions. We suggest that psychological factors (expectation and perceptions) influence both a woman's decision of birthplace and the actual birth process. (BIRTH 31:1 March 2004)