Die Wahl des Geburtsorts - Eine Analyse der Entscheidungskriterien schwangerer Frauen am Beispiel des Hebammenkreißsaals

Abstract

The concept of midwife-managed delivery units (MDUs) is relatively new in Germany. The first one was implemented in the city of Bremerhaven in 2003. This concept offers midwifery delivery care while acknowledging the fact that 98% of the childbearing women in Germany decide to give birth in a hospital. This approach is also supposed to counteract the medicalization of clinical obstetric care and to thereby reduce the over and inappropriate utilization of health care. So far, it is unknown whether the MDU meets the needs of pregnant women in Germany. Aim The aim of the study was to explore the decision making criteria of pregnant women to give birth at a MDU or at the standard delivery unit. Methods A longitudinal qualitative study was carried out. Twenty-nine women, who planned to give birth at a hospital in Bremerhaven were interviewed during pregnancy and after puerperium. Participation was voluntary and informed consent was obtained in order to meet ethical requirements. The interviews where conducted using a list of questions about several aspects of delivery care. It was also of interest, if women were able to identify the delivery unit, which fits their individual needs best. At the post-delivery interview, any changes in deciding for one or the other concept of care were assessed. The interviews were analysed using content analysis (Mayring 2000). The study was carried out from February 2004 until March 2007. Results Aspects of security and being self-determined influenced the choice of the delivery unit. Another important aspect was the desired health care provider. Dependent on the individual perception, whether pregnancy and birth were seen as a risky or as a normal life event, women chose the standard medical care or the midwifery care. The decision was persistent before and after birth in most cases. Conclusions A positive birth experience seems to depend more on a trustworthy relationship with the delivery-midwife, than on the chosen concept. The continuity of care benefits from several offers like acupuncture or midwife consultations which therefore contribute to a good basis for a trustworthy relationship between woman and midwife. In order to achieve demedicalisation in clinical birth settings, it is necessary to develop approaches that involve not only professionals, but also users.