Do low risk women actually birth in their planned place of birth and does ethnicity influence women's choices of birthplace?

Purpose: Midwives practising as lead maternity
caregivers in New Zealand (NZ) provide
continuity of care to women who choose to give
birth in a variety of settings including home,
primary maternity units, secondary and tertiary
level hospitals. The purpose of this study was to
compare how frequently the planned place of birth
matched the actual place of birth for a cohort of
low risk women in the care of midwives and to
identify whether ethnicity influences women’s
choices in relation to planned place of birth.
Method: The Midwifery and Maternity
Provider Organisation (MMPO) database was
accessed with agreement from the NZ College
of Midwives (NZCOM). Ethical approval
was gained from the NZ Multi-region Ethics
Committee. Data were obtained from the
MMPO database from 2006-2007 for a total
of 39,667 births. Data were reduced through
exclusion criteria to establish the cohort of
16,453 low risk women (41.47% of total
sample) according to planned birthplace. The
Stata statistical package was used to analyse data
for this cohort of low risk women.
Results: Within the total cohort (n=16,453),
9.36% of women had a homebirth, 16.25%
of women birthed in a primary maternity unit
and 74.36% of women birthed in a secondary/
tertiary hospital. Five women (0.03%) birthed
in an atypical small maternity unit with
access to epidural analgesia. This facility was
categorised as a ‘primary plus’ facility and is
different from primary units and secondary/
tertiary hospitals. Of the women planning
a homebirth, 82.68% (n =1,513) gave birth
at home. Just over ninety percent (n= 2,594)
of women planning to birth in a primary
maternity unit gave birth in this setting
and over 99% of women planning birth in
secondary/tertiary hospitals (n = 12,066) gave
birth there. Only 3.95% of multiparous women
did not give birth in their planned birthplace
as compared with 6.02% of primiparous
women. This result was statistically significant
(panalysed by ethnicity and by the percentage of
each ethnicity that planned to birth at home,
primary, and secondary/tertiary settings.
Twenty three percent of Māori women chose
to birth in a primary maternity unit compared
with 18% of NZ European, 14% Pacifica and
10% of Asian women. Thirteen percent of NZ
European women planned homebirth compared
with 9% of Māori, 7% Pacifica and 4% of Asian
women. There was no statistically significant
difference between ethnic groups and their
planned and actual birthplace.
Conclusion: There is a high association between
intended and actual birthplace in relation to
homebirth and primary maternity units; parous
women were significantly more likely to give birth
in their planned birthplace. While only a quarter
of this low risk cohort chose to give birth in the
low technology settings of home or a primary
maternity unit, this study shows that women who
planned to birth in such settings, generally did so.
Māori women were the ethnic group most likely to
choose a primary maternity unit as their planned
birthplace. It is important that low risk women
continue to be able to choose their place of birth
and that primary maternity units are available
to them. This may be particularly important for
indigenous NZ women.