The impact of birthplace on women's birth experiences and perceptions of care.

Overall birth experience is an important outcome of birth, and studies of psycho-social birth outcomes and women's perspectives on care are increasingly used to evaluate and develop maternity care services. We examined the influence of birthplace on women's birth experiences and perceptions of care in two freestanding midwifery units (FMU) and two obstetric units (OU) in north Denmark, all pursuing an ideal of high-quality, humanistic and patient-centred care. As part of a matched cohort study, a postal questionnaire survey was undertaken. Two hundred and eighteen low-risk women in FMU care, admitted between January-October 2006, and an obstetrically/socio-demographically matched control group of 218 low-risk women admitted to an OU were invited to participate. Three hundred and seventy-five women (86%) responded. Birth experience and satisfaction with care were rated significantly more positively by FMU than by OU women. Significantly better results for FMU care were also found for specific patient-centred care elements (support, participation in decision-making, attentiveness to psychological needs and to wishes for birth, information, and for women's feeling of being listened to). Adjustment for medical birth factors slightly increased the positive effect of FMU care. Subgroup analysis showed that a significant, negative effect of low education and employment level on birth experience was found only for the OU group. Our results provide strong support of FMU care and underline the big challenges in providing individual and supportive care for all women, especially in OUs. Policy-makers and professionals need to consider how the advantages provided by FMU care can support the effort to improve women's birth experience and possibly also the combat of the negative effect of social disadvantage on health.