Qualitative interviews highlighted hospitals as the taken-for-granted site for birth.

Midwives build confidence in a primary centre birth through discursive and visual cues that re-centre birth as a normal physiological experience.

Midwives' understanding of birth as a neurohormonal experience led to support for birth where clients felt safe.

Growing rates of intervention in birth may reinforce perceptions of hospital as the safe place to birth, undermining primary birth centres.

High rates of intervention in birth is a significant health issue. Primary birth centres are midwife-led sites for care with lower rates of intervention in birth than hospitals. Yet hospital births dominate birthplace decision-making in New Zealand. In-depth interviews with 24 health workers associated with four primary birth centres aim to identify how confidence in a primary centre birth is built. Thematic analysis demonstrates how midwives discursively and visually re-centred birth as a normal physiological process challenging hospital as the taken-for-granted place for care. We conclude that midwives’ neurohormonal understandings of birth builds responsiveness to the birth-place ontologies of clients.

Primary birth

Midwifery

Reproductive health

Birthplace decision-making

© 2025 The Authors. Published by Elsevier Ltd.