Place of birth and satisfaction with childbirth in Belgium and the Netherlands.

OBJECTIVE

to gain insight into the association between satisfaction with childbirth and place of birth, in the context of two maternity-care systems, in Belgium and the Netherlands. The Belgian and Dutch societies have many similarities but differ in the organisation of maternity care. The Dutch way of giving birth is well known for its high percentage of home births and its low medical intervention rate. In contrast, home births in Belgium are uncommon and the medical model is taken for granted.

DESIGN

quantitative, comparative study using questionnaires to assess satisfaction with childbirth.

SETTING

hospitals and independent midwifery practices in two comparable cities in Belgium and the Netherlands.

PARTICIPANTS

two questionnaires were completed by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth, at home or in hospital. The women were invited to participate in the study by independent midwives and obstetricians during prenatal visits between 2004 and 2005.

MEASUREMENTS AND FINDINGS

satisfaction with childbirth was measured by the Mackey Satisfaction with Childbirth Rating Scale, which takes into account the multi-dimensional nature of the concept. An analysis of variance with two fixed factors, planned place of birth and maternity-care system, shows that women who had planned for a home birth were more satisfied than women who had planned for a hospital birth. This was true in every subdimension of satisfaction. Belgian women were more satisfied with childbirth than their northern neighbours, in every subdimension. The higher satisfaction scores of the Belgian women accounted for both home and hospital births.

KEY CONCLUSIONS

women who had planned a home birth were the most satisfied (in both countries), but Belgian women had higher satisfaction scores than Dutch women. This is paradoxical because a non-medical home context has a beneficial effect on satisfaction, whereas the Dutch non-interventionist approach in maternity care does not yield the same effect.

IMPLICATIONS FOR PRACTICE

medicalisation critics may be right about the iatrogenic effects of the medical approach on an individual level, but other social forces operate on the level of maternity-care systems.