Birth setting decisions during COVID-19: A comparative qualitative study

Background: The COVID-19 pandemic resulted in an increased number of out-of-hospital births in the United States and other nations. While many studies have sought to understand the experiences of pregnant and birthing people during this time, few have compared experiences across birth locations.Objective: The purpose of this study is to compare the narratives and decision-making processes of those who gave birth in and out of hospitals during the pandemic.Design: We conducted semi-structured narrative interviews with 24 women who gave birth during the COVID-19 pandemic.Methods: Interviews were transcribed and coded, and a thematic narrative analysis was employed. Final themes and exemplary quotes were determined in discussion among the research team.Results: Results from narrative analysis revealed three themes that played into participants' birth location decisions: (1) birth efficacy and values, (2) diverse definitions of safety, and (3) childcare and other logistics. In each of these themes, participants who gave birth in birthing centers, at the hospital, and at home describe their individualized approach to achieving a supportive birth environment while mitigating the risk of labor complications and COVID-19 infection.Conclusion: Our study suggests that for some childbearing people, the pandemic did not change birthing values or decisions but rather brought enhanced clarity to their individual needs during birth and perceived risks, benefits, and limitations of each birthing space. This study further highlights the need for improved structural support for birthing people to access a range of safe and supportive birthing environments.