McAllister Sophie, Litchfield Claire
Consultant Midwife at Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Consultant Midwife Trainee at Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Birth. 2025 Mar;52(1):46-54. doi: 10.1111/birt.12827. Epub 2024 May 23.
Decision-making around birthplace is complex and multifactorial. The role of clinicians is to provide unbiased, evidence-based information to support women and birthing people to make decisions based on what matters to them. Some decisions may fall outside of clinical guidance and recommendations. Birth Choices Clinics can provide an opportunity for extended discussion and personalized birthplace planning. This study aimed to explore the rationale behind choosing birthplace "outside of guidance" and examine the outcomes for women who attended a Birth Choices Clinic.
The study was descriptive using data extracted from clinical documentation and consultation. The data included demographic information, maternal characteristics, reason for choosing a midwifery-led birth setting, birthplace preference, and outcome.
Eighty-two women used the Birth Choices Clinic between April 2022 and February 2023 in one large maternity unit in the UK. Reasons for choosing birth in a midwifery-led setting included having access to a birthing pool, to reduce the chance of obstetric interventions and pragmatic reasons. Sixty-five percent of women experienced a spontaneous vaginal birth, 10% experienced an assisted vaginal birth, and 23% experienced a cesarean birth. Of the 33 women who ultimately commenced labor care in a midwifery-led setting, 76% (n = 25/33) birthed in this setting without complications. Transfer rates in labor were similar to those in a "low-risk" pregnant population.
Birth choice clinics may facilitate an understanding of material risk and support individualizing birth planning. There is evidence that women changed their planned birthplace, possibly in recognition of a move along the risk spectrum.
关于分娩地点的决策复杂且受多种因素影响。临床医生的职责是提供公正、基于证据的信息，以支持女性和分娩者根据自身重要事项做出决策。有些决策可能超出临床指导和建议的范围。分娩选择诊所可以提供进行深入讨论和个性化分娩地点规划的机会。本研究旨在探讨选择“超出指导范围”的分娩地点背后的理由，并研究参加分娩选择诊所的女性的分娩结局。
本研究采用描述性研究方法，数据取自临床记录和会诊资料。数据包括人口统计学信息、产妇特征、选择由助产士主导的分娩环境的原因、分娩地点偏好及分娩结局。
2022年4月至2023年2月期间，英国一家大型产科单位有82名女性使用了分娩选择诊所。选择在助产士主导的环境中分娩的原因包括可使用分娩池、减少产科干预的可能性以及实际原因。65%的女性顺产，10%的女性经助产阴道分娩，23%的女性剖宫产。在最终在助产士主导的环境中开始分娩护理的33名女性中，76%（n = 25/33）在此环境中分娩且无并发症。分娩时的转诊率与“低风险”孕妇群体相似。
分娩选择诊所可能有助于理解产妇风险并支持个性化分娩计划。有证据表明女性改变了她们计划的分娩地点，这可能是认识到风险程度发生了变化。
