Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy

Backgroundthe rate of caesarean in Australia is twice that of Sweden. Little is known about women's attitudes towards birth in countries where the caesarean rate is high compared to those where normal birth is a more common event.Objectivesto compare attitudes and beliefs towards birth in a sample of Australian and Swedish women in mid-pregnancy.Participantswomen from rural towns in mid Sweden (n=386) and north-eastern Victoria in Australia (n=123).Methodsquestionnaire data was collected from 2007 to 2009. Levels of agreement or disagreement were indicated on sixteen attitude and belief statements regarding birth. Principal components analysis (PCA) identified the presence of subscales within the attitudes inventory. Using these subscales, attitudes associated with preferred mode of birth were determined. Odds ratios were calculated at 95% CI by country of care.Resultsthe Australian sample was less likely than the Swedish sample to agree that they would like a birth that: ‘is as pain free as possible' OR 0.4 (95% CI: 0.2–0.7), ‘will reduce my chance of stress incontinence' OR 0.2 (95% CI: 0.1–0.8), ‘will least affect my future sex life' OR 0.3 (95% CI: 0.2–0.6), ‘will allow me to plan the date when my baby is born' OR 0.4 (95% CI: 0.2–0.7) and ‘is as natural as possible' OR 0.4 (95% CI: 0.2–0.9). They were also less likely to agree that: ‘if a woman wants to have a caesarean she should be able to have one under any circumstances’ OR 0.4 (95% CI: 0.2–0.7) and ‘giving birth is a natural process that should not be interfered with unless necessary’ OR 0.3 (95% CI: 0.1–0.7). Four attitudinal subscales were found: ‘Personal Impact of Birth', ‘Birth as Natural Event', ‘Freedom of Choice' and ‘Safety Concerns'. Women who preferred a caesarean, compared to those who preferred a vaginal birth, across both countries were less likely to think of ‘Birth as a natural event’.Key conclusionsthe Australian women were less likely than the Swedish women to hold attitudes and beliefs regarding the impact of pregnancy and birth on their body, the right to determine the type of birth they want and to value the natural process of birth. Women from both countries who preferred caesarean were less likely to agree with attitudes related to birth as a natural event.