Choosing a birth attendant: the influence of a woman's childbirth definition

This study examines the impact of a woman's childbirth definition or beliefs on selecting either a Certified Nurse Midwife (CNM) or an obstetrician. The global hypothesis is that women who define birth as "natural" and "normal" are more likely to select a CNM than women who define it as "in need of medical attention." The quantitative and qualitative data were collected over a period of 2 years from 200 pregnant women enrolled in a central New Jersey health maintenance organization (HMO) which had contracted with an independent group of CNMs to provide midwifery care to its clientele. The findings indicate that after controlling for risk-eligibility, women who define childbirth as "risky" and requiring technical medical intervention are more likely to select an obstetrician, while those who define it as "natural" and "normal" are more likely to select a Certified Nurse Midwife. Additionally, a number of social characteristics such as expectation of information, support from the baby's father, and a low desire for control over the birth process are related to selecting a CNM. Anticipated choice, measured at the first prenatal visit, is positively related to eventual choice, indicating that early pregnancy definitions accurately predict service usage. Factors affecting birth attendant selections for first-time mothers were somewhat different than those affecting non-first time mothers. Namely, non-first-time mothers were less influenced by perceived childbirth risks and expectations of information than first-time mothers. The implication of these findings is that by selecting providers who share their varying childbirth beliefs, women evaluate and endorse particular profession's practice style as most appropriate.