New research led by Western Sydney University has found over 85 per cent of women in Australia would make different maternity care choices if they had another baby, including around advocating for themselves, the type of birth, and model of care.
Published in the BMJ Open today, the research analysed data from the Birth Experience Study (BESt) online survey, which is one of the largest studies into maternity experiences in Australia.
As part of the BESt survey, in 2021, 6,101 women responded to the open question ‘Would you do anything different if you were to have another baby’. Researchers then analysed and grouped the women’s responses into six categories. These included:
- ‘I want to be a better advocate for myself’ – 3958 comments, 39.2 per cent – described how women reflected on their previous experience, feeling the need to better advocate for themselves in the future to receive the care or experience they wanted.
- ‘I want a specific birth experience’ – 2872 comments, 28.5 per cent – highlighted the types of birth women would choose for their next pregnancy and this was most often a vaginal birth.
- ‘I want a specific model of care’ – 1796 comments, 17.8 per cent – highlighted the model of care women would choose for their next pregnancy and this was most often continuity of midwifery care.
- ‘I want better access’ – 294 comments, 2.9 per cent – identified financial and/or geographical constraints women experience trying to make choices for birth.
- Two categories included comments from women who said, ‘I don’t want to change anything’ – 1027 comments, 10.2 per cent, and ‘I don’t want another pregnancy’ – 142 comments, 1.4 per cent. Women who said they would not change anything were more likely to have had continuity of care.
Study lead Dr Hazel Keedle from the University’s School of Nursing and Midwifery and Translational Health Research Institute said the research identified that women predominantly want to avoid a repeat of their previous pregnancy and birth experience.
“Of the women who responded to the open question, ‘Would you do anything different if you were to have another baby’, 85 per cent left a comment related to making different decisions regarding their next birth choices,” said Dr Keedle.
“Concerningly, women appear to blame themselves for their previous birth experience. They are also determined to plan and be better prepared for future births and mostly see vaginal birth, with minimal intervention, in a midwifery continuity of care model as important for the next birth.”
Study co-author Professor Hannah Dahlen AM, who is also from the University’s School of Nursing and Midwifery and Translational Health Research Institute, said the findings highlight that women need to be supported to choose the right model of care that is best suited to their individual values.
“Support is critical, especially for a woman’s first birthing experience, early in pregnancy, and preferably before pregnancy, as this could reduce the disconnect between expectations and reality and subsequently reduce regrets and birth trauma,” said Professor Dahlen.
“Women who stated that they would do something different for their next birth are more likely to describe their birth as traumatic. Being informed of their choices and making personalised decisions regarding the available models of care would ideally lead to less regret and improved birth experiences.”
The study also revealed a need for increased access to midwifery services where there is a continuity of care from early pregnancy through to after the baby is born.
Australian Institute of Health and Welfare data shows that midwifery continuity of care models make up around 15 per cent of all models of care available currently.
“There are vast areas of Australia without access resulting in many women being unable to secure a position in a local midwifery group practice due to a lack of spaces available or options in their geographical area,” added Dr Keedle.
“It is imperative that culturally safe continuity of midwifery care is available for all women across Australia, including those in regional, rural and remote communities. Further research is needed to explore the impact of providing midwifery-led maternity services in these communities on women’s experiences.”
The research team wish to acknowledge the contributions of Western Sydney University midwifery student Risharda Lockwood, who undertook the preliminary analysis of the data for this study, supervised by Dr Keedle and Professor Dahlen as part of the Summer Scholars program.
The research was supported by a School of Nursing and Midwifery Partnership Grant through Western Sydney University, The Qiara Vincent Thiang Memorial Award and Maridulu Budyari Gumal SPHERE Maternal, Newborn and Women’s Clinical Academic Group funding.
