Trade-off between local access and safety considerations in childbirth: Rural Tasmania women's perspectives

Objectives: This study investigates: (i) Tasmanian rural women’s preferences for different models of intrapartum care; (ii) their preferences for travel time to safe delivery; and (iii) factors which influence these preferences. Design: Mixed-methods study using a survey questionnaire and semistructured interviews was adopted. A questionnaire explored women’s preferences for different models of care and preferred travel time. Interviews were conducted to validate the survey results and provide insightful information on their preferences on the models of care. Women who have had rural childbirth experiences from six Tasmanian rural communities were invited to participate in the study. Results: Two hundred and ten women completed the questionnaire with a response rate of 35%. Twenty-two follow-up interviews were conducted. The survey found that women preferred to give birth in a hospital setting to homebirth despite having to travel for two hours. Midwifery-led care with one hour travel time was the second preferred model of care. Women were willing to travel to access the regional hospital but within limit. Their preferences suggest that women have to trade-off between local access and safety considerations. The interviews validate the survey results. Three main themes emerged from the interview data namely (i) safety; (ii) distance from hospital; and (iii) type of delivery. Their preferences were associated with their maternal care experiences in the past. Conclusion: In order to achieve the maternity services that are woman centred and respond to the needs and preferences of women, the service design and provision should take into account these women’s preferences.