Maternal attitudes towards home birth and their effect on birth outcomes in Iceland: A prospective cohort study

• Published in: Midwifery 2016-03, Vol.34, p.95-104
• Main Authors: Halfdansdottir, Berglind, Olafsdottir, Olof A., Hildingsson, Ingegerd, Smarason, Alexander Kr, Sveinsdottir, Herdis
• Format: Article
• Language: English
• Subjects: Adult; Childbirth and Health; Cohort Studies; Female; Health Knowledge, Attitudes, Practice; Home Childbirth; Humans; Iceland; Interventions; Maternal attitude; Medicin och hälsovetenskap; Midwifery; Mothers - psychology; Nursing; Pregnancy; Pregnancy Outcome; Pregnancy outcomes; Prenatal Care; Prospective Studies; Surveys and Questionnaires; Young Adult
• ISSN: 0266-6138; 1532-3099; 1532-3099
• DOI: 10.1016/j.midw.2015.12.010

to examine the relationship between attitudes towards home birth and birth outcomes, and whether women’s attitudes towards birth and intervention affected this relationship. a prospective cohort study. the study was set in Iceland, a sparsely populated island with harsh terrain, 325,000 inhabitants, high fertility and home birth rates, and less than 5000 births a year. a convenience sample of women who attended antenatal care in Icelandic health care centres, participated in the Childbirth and Health Study in 2009–2011, and expressed consistent attitudes towards home birth (n=809). of the participants, 164 (20.3%) expressed positive attitudes towards choosing home birth and 645 (79.7%) expressed negative attitudes. Women who had a positive attitude towards home birth had significantly more positive attitudes towards birth and more negative attitudes towards intervention than did women who had a negative attitude towards home birth. Of the 340 self-reported low-risk women that answered questionnaires on birth outcomes, 78 (22.9%) had a positive attitude towards home birth and 262 (77.1%) had a negative attitude. Oxytocin augmentation (19.2% (n=15) versus 39.1% (n=100)), epidural analgesia (19.2% (n=15) versus 33.6% (n=88)), and neonatal intensive care unit admission rates (0.0% (n=0) versus 5.0% (n=13)) were significantly lower among women who had a positive attitude towards home birth. Women’s attitudes towards birth and intervention affected the relationship between attitudes towards home birth and oxytocin augmentation or epidural analgesia. the beneficial effect of planned home birth on maternal outcome in Iceland may depend to some extent on women’s attitudes towards birth and intervention. Efforts to de-stigmatise out-of-hospital birth and de-medicalize women‘s attitudes towards birth might increase women׳s use of health-appropriate birth services. •Women׳s attitudes towards birth, intervention and home birth are related.•Positive attitudes towards home birth are related to lower intervention rates.•Attitudes towards birth and intervention confound this relationship.•De-medicalizing women’s attitudes towards birth may influence use of birth services.