Investigation into birthing facility selection to explain the decreasing number of births at birthing centers:

Objective<br> This study aims to investigate and compare reasons for birthing facility selection from hospitals, obstetrics clinic and birthing centers using a marketing concept in order to explain and discuss the decreasing number of births at birthing centers.<br>Subjects and methods<br> A questionnaire survey was conducted on 725 mothers using health centers, birthing centers, and infant activity classes in Tokyo. Survey content comprised participant attributes, reasons for birthing facility selection, and influencing factors. Responses from 389 mothers (valid response rate, 53.7%) were analyzed. Participants were categorized based on their choice of birthing facility type as group A (hospital or university hospital), B (obstetrics clinic), or C (birthing center or home) and were compared regarding attributes and the marketing mix (the four Ps: Product, Price, Place, and Promotion). In the present medical context, Product referred to care, medical services, and medical practice. The survey was conducted between February and the end of March 2013.<br>Results<br> Group A comprised more elderly primipara than groups B and C (p=0.027), and "aged 35 years or older" was more commonly cited as a factor influencing facility selection in group A than groups B and C (p‹0.001). "Long and thorough prenatal checkups", "option for natural birth", "option for freestyle birth", "midwife in attendance throughout labor and delivery", "provision of breastfeeding support", "option for rooming-in", and "meals beneficial for breast milk" were stated as Product-related reasons for birthing facility selection in 70% of group C compared to around 30% of groups A and B. Reasons such as "every prenatal checkup includes examination by a doctor" and "facility is large-scale" were common in group A while reasons such as "every prenatal checkup includes examination by a doctor", "availability of private rooms", "lavish meals", and "celebration meal offered" were common in group B (p‹0.001).<br> With regard to Price, "low cost of birth" was a commonly stated reason for birthing facility selection in group A (p‹0.001), while "able to use government-issued coupons for prenatal checkups" was commonly stated by groups A and B (p=0.015). For Place, half of all three groups responded with "close to home" as a reason for facility selection"<br>Conclusion<br> Possible reasons for fewer births at birthing centers are being an elderly primipara (age≥35 years old) and the gap between What Product (Service Care) midwives are providing and what service care mothers in Group A (mothers at university hospital and obstetrics clinic) wanting to receive.