First-time mothers’ birth beliefs, preferences, and actual birth: A longitudinal observational study

Problem: Birth preferences, such as mode and place of birth and other birth options, have important individual and societal implications, yet few studies have investigated the mechanism which predicts a wide range of childbirth options simultaneously. Background: Basic beliefs about birth as a natural and as a medical process are both predictive factors for childbirth preferences. Studies investigating birth beliefs, preferences, and actual birth are rare. Aim: To test a predictive model of how these beliefs translate into birth preferences and into actual birth related-options. Methods: Longitudinal observational study including 342 first-time expectant mothers recruited at women's health centres and natural birth communities in Israel. All women filled out questionnaires including basic birth beliefs and preferred birth options. Two months postpartum, they filled out a questionnaire including detailed questions regarding actual birth. Findings: Stronger beliefs about birth being natural were related to preferring a more natural place and mode of birth and preferring more natural birth-related options. Stronger beliefs about birth being medical were associated with opposite options. The preferences mediated the association between the birth beliefs and actual birth. The beliefs predicted the preferences better than they predicted actual birth. Discussion: Birth beliefs are pivotal in the decision-making process regarding preferred and actual birth options. In a medicalized obstetric system, where natural birth is something women need to actively seek out and insist on, the predictive powers of beliefs and of preferences decrease. Conclusion: Women's beliefs should be recognized and birth preferences respected.