Birth attendant choice and satisfaction with antenatal care: the role of birth philosophy, relational style, and health self-efficacy

The purpose of this study was to examine the association of women’s birth‐related beliefs and expectations with the choice of a midwife or obstetrician birth attendant, and her satisfaction with antenatal care. Data were collected from 133 women with a low‐risk pregnancy who had consultations with their chosen birth attendant, and who lived in one of four Canadian provinces that publicly funded midwifery. A new birth philosophy scale was developed and tested, with natural and medical birth philosophies emerging as separate factors. Univariate analyses indicated that women with a midwife scored higher on natural birth philosophy, health self‐efficacy, egalitarian relational style preference, and openness than women with an obstetrician as caregiver. Multivariate analysis revealed that natural birth philosophy was the only significant factor distinguishing the choice of birth attendant. Women with a midwife scored higher on all satisfaction dimensions, and natural birth philosophy was a significant correlate of satisfaction. Findings suggest that women’s beliefs about pregnancy and childbirth are more sophisticated than a simple dichotomy of the natural versus the medical, and highlight the importance of ‘fit’ between a woman and her maternity caregiver.