Normality and collaboration: mothers’ perceptions of birth centre versus hospital care Karen Coyle,Yvonne Hauck, Patricia Percival and Linda Kristjanson Objective: to describe women’s perceptions of care in Western Australian birth centres following a previous hospital birth. Design, setting and participants: an exploratory design was used to study the care experiences of 17 women recruited from three Western Australian birth centres. Data were obtained from in-depth interviews that explored women’s perceptions of their care in both the birth centre and hospital context. Findings: four key themes emerged from the analysis: ‘beliefs about pregnancy and birth’, ‘nature of the care relationship’,‘care interactions’, and ‘care structures’.The themes of ‘beliefs about pregnancy and birth’ and ‘nature of the care relationship’ are discussed in this paper. Beliefs about pregnancy and birth refer to the philosophical underpinnings of pregnancy and birth held by women and their carers. Nature of the care relationship identi¢es women’s perceptions of their relationship with health professionals. Care interactions and care structures will be described in a subsequent paper. Key conclusions and implications for practice: The women’s comments suggested di¡erences in philosophy between hospital and birth-centre settings.The philosophy and beliefs of caregivers was an important component of the care experience.Women valued the normality of the birth-centre approach and the opportunity to experience the birth of their child with collaborative support from a midwife. & 2001 Harcourt Publishers Ltd INTRODUCTION During the 1990s in Australia, birth-centre care emerged as a major alternative to mainsteam maternity services. A recent survey to determine birth-centre practices in Australia revealed that before 1990 there were only three birth centres operating in Australia, compared with 24 in 1997 (Waldenstrom & Lawson 1998). The expansion of the birth-centre option has occurred alongside the development of other midwifery models of care, such as team midwifery and government funded home births. This expansion has been in response to a number of ministerial reviews of maternity services at both state and national level, which recommended the development of alternatives to mainstream services (Health Department of New South Wales 1989, Health Department of Victoria 1990, Health Depart- ment of Western Australia 1990, National Health & Medical Research Council 1996). As a result, some of the alternative models of care developed were funded through government schemes. The development of birth centres has occurred in response to concerns over medicalisation of ‘normal birth’, with the obstetric culture in Australia being characterised by high rates of intervention (Day et al. 1997). Care in the birth centre context is based on the philosophy that childbirth is a natural physiological process and largely a social event rather than a medical one (Matthews & Zadak 1991). Care provision reflects this attitude with limited use of technol- ogy and a client-centred focus, where women and their families are involved in the decision-making process. Continuity of care throughout the childbearing continuum from a small team of Karen L. Coyle RN, RM, BHlthSc(Nur), MN, Family Birth Centre, King Edward Memorial Hospital, Bagot Road, Subiaco, WA, Australia 6008 Yvonne Hauck BScN, MSc, PhD, RM, Edith Cowan University, School of Nursing & Public Health, Pearson Street, Churchlands, WA, Australia 6018. E-mail: y.hauck@ecu.edu.au Patricia Percival PhD, FRCNA, RN, RM, Linda J. Kristjanson MN, PhD, RN, BN, Professor, Faculty of Communications, Health and Science, Edith Cowan University, Pearson St, Churchlands, WA, Australia 6018 (Correspondence to KC) Received 31 May 2000 Revised 6 October 2000 Accepted 22 February 2001 Published online 6 June 2001 Midwifery (2001) 17, 182^193 & 2001 Harcourt Publishers Ltd doi:10.1054/midw.2001.0256, available online at http://www.idealibrary.com on