The 130th Annual Meeting of APHA

Abstract #51406

Heather A. Davidson, MS, David S. Cordray, PhD, and Liz Johnson, BS. Department of Psychology and Human Development, Vanderbilt University, Box 512 - Peabody, Nashville, TN 37212, 615-343-3420, heather.a.davidson@vanderbilt.edu

The simple act of asking women to explain the decisions underlying their choice of prenatal care and childbirth services can help develop an agenda for the continual refinement of the freestanding birth center (FBC) concept. As part of the Kellogg Birth Center Evaluation in Tennessee, we are studying how FBCs affect women's access to maternity care. A semi-structured questionnaire was developed to interview women about their decision-making strategies. Participants received care at either a university hospital or a freestanding birth center. From their interviews, we identified 10 major factors that affect women's choice. Consistent with prior research on medical decision-making and alternative types of care, many women choosing FBCs relied on various sources of information and demonstrated a more complex decision-making process. Women receiving care at the hospital, however, varied on the complexity of their strategies. Those with remarkably simple strategies highlighted existing limitations in the access of maternal health services including: insurance restrictions, geographical barriers, absence of information and awareness of alternatives, and misconceptions of services. Results suggest that while some women are very satisfied with each type of service based on their decision strategies, there are many women either unable or unaware of the FBC concept that might find it more empowering. The interviews also highlight a number of important opportunities for continual organizational development, policy refinements and future research on the FBC system of care. By targeting the specific factors affecting women's decision strategies, FBCs have the opportunity to meet the needs of more women during pregnancy and childbirth.

Learning Objectives:

At the end of this presentation, attendees will be able to discuss how women's decision strategies help (
• identify limitations of access to maternity health services and (
• identify opportunities for refining outreach efforts at freestanding birth centers.

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I acknowledge reading the APHA disclosure policy. The research presented in this talk is part of a larger project: The Kellogg Birth Center Evaluation. The project is funded by the W.K. Kellogg Foundation.