Deciding on home or hospital birth: Results of the Ontario choice of birthplace survey

OBJECTIVE: decision-making autonomy regarding where to give birth is associated with maternal satisfaction with childbirth but how women decide their location of birth is poorly understood. The aim of this study was to understand how pregnant women in Ontario, Canada decide to give birth at home or hospital and why they choose one birthplace over another. DESIGN: a mixed methods survey completed by midwifery clients in Ontario pertaining to sources of information about choice of birthplace and decision-making priorities. FINDINGS: decisions about choice of birthplace are made before becoming pregnant or during the first trimester. Books and research are important sources of information for women when deciding where to give birth. Women who planned home birth wanted to avoid interventions and felt most comfortable at home. Those who planned hospital birth wanted access to pain medication and found the idea of home birth stressful. Questions about the safety of home birth are a critical barrier to those who are undecided about where to give birth. KEY CONCLUSIONS: beliefs and values about birth and the desire for pain relief options play significant roles in women׳s decisions, but are balanced with views of safety and risk. Regardless of where they have their baby, midwifery clients believe that birth is a natural process. IMPLICATIONS FOR PRACTICE: the findings provide health care providers and women with a deeper understanding of the factors for consideration when deciding where to give birth.