Women’s reasons and perceptions around planning a homebirth with a registered midwife in Western Australia

Exploring home births in Catalonia (Spain): A cross-sectional study of women's experiences and influencing factors

AIM

The study explores the experiences of women with low-risk pregnancies and no complications who planned a home birth.

DESIGN

A cross-sectional study was conducted using an online questionnaire.

METHODS

The questionnaire included socio-demographic, obstetric and perinatal variables. Birth satisfaction was evaluated via the Spanish version of the childbirth experience questionnaire. The study group comprised home-birthing women in Catalonia, Spain. Data were collected from 1 January 2019 to 31 December 2021. Statistical analysis was performed using SPSS.

RESULTS

A total of 236 women responded. They reported generally positive experiences, with professional support and involvement being the most highly rated dimensions. Better childbirth experiences were associated with labour lasting less than 12 h, no perineal injuries, no intrapartum transfers to hospital, euthocic delivery and the presence of a midwife.

CONCLUSIONS

Women's positive home birth experiences were linked to active participation and midwife support. Multiparous women felt safer. Medical interventions, especially transfers to hospitals, reduced satisfaction, highlighting the need for improved care during home births.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Home births should be included among the birthplace options offered by public health services, given the extremely positive feedback reported by women who gave birth at home.

IMPACT

Home birth is not an option offered under Catalonia's public health system only as a private service. The experience of home-birthing women is unknown. This study shows a very positive birth experience due to greater participation and midwife support. The results help stakeholders assess home birth's public health inclusion and understand valued factors, supporting home-birthing women.

REPORTING METHOD

The study followed the STROBE checklist guidelines for cross-sectional studies.

PUBLIC CONTRIBUTION

Women who planned a home birth participated in the pilot test to validate the instrument, and their contributions were collected by the lead researcher. The questionnaire gathered the participants' email addresses, and a commitment was made to disseminate the study's results through this means.

Exploring the Role of Birth Environment on Italian Mothers' Emotional Experience during Childbirth

The physical environment is one of the factors that affect mother's experience of childbirth and psychological health. A woman's childbirth experience has been found to influence not only the mother's own health and future births but also the well-being of her child and family. The present study's objective was to investigate mothers' perceptions of spatial-physical humanization, affective quality of place, and emotions during childbirth. To achieve this goal, the first part of our work was dedicated to selecting two birth environments (hospital and birth center) with different degrees of humanization. The methods include observations and field survey which mainly concerned the environmental quality of the spaces and the layout of the birth unit, and self-report questionnaire about perceived environment, affective quality attributed to place, and delivery experience. Participants are 66 low-risk women, choosing hospital or birth center. The findings indicate an enhanced perception of both the spatial-physical aspects and the social and functional aspects of the care unit among mothers who give birth at the birth center. These same mothers also report a more positive perception of the childbirth experience. In conclusion, this study contributes to the understanding of the role of birth environments in shaping mothers' emotional experiences during childbirth.

Midwifery care during labor and birth in the United States

The intrapartum period is a crucial time in the continuum of pregnancy and parenting. Events during this time are shaped by individuals' unique sociocultural and health characteristics and by their healthcare providers, practice protocols, and the physical environment in which care is delivered. Childbearing people in the United States have less opportunity for midwifery care than in other high-income countries. In the United States, there are 4 midwives for every 1000 live births, whereas, in most other high-income countries, there are between 30 and 70 midwives. Furthermore, these countries have lower maternal and neonatal mortality rates and have consistently lower costs of care. National and international evidences consistently report that births attended by midwives have fewer interventions, cesarean deliveries, preterm births, inductions of labor, and more vaginal births after cesarean delivery. In addition, midwifery care is consistently associated with respectful care and high patient satisfaction. Midwife-physician collaboration exists along a continuum, including births attended independently by midwives, births managed in consultation with a physician, and births attended primarily by a physician with a midwife acting as consultant on the normal aspects of care. This expert review defined midwifery care and provided an overview of midwifery in the United States with an emphasis on the intrapartum setting. Health outcomes associated with midwifery care, specific models of intrapartum care, and workforce issues have been presented within national and international contexts. Recommendations that align with the integration of midwifery have been suggested to improve national outcomes and reduce pregnancy-related disparities.

Challenging norms: Making non-normative choices in childbearing. Results of a meta ethnographic review of the literature

OBJECTIVE

Women have the right to make choices during pregnancy and birth that sit outside clinical guidelines, medical recommendations, or normative expectations. Declining recommended place or mode of birth, routine intervention or screening can be considered 'non-normative' within western cultural and social expectations around pregnancy and childbirth. The aim of this review is to establish what is known about the experiences, views, and perceptions of women who make non-normative choices during pregnancy and childbirth to uncover new understandings, conceptualisations, and theories within existing literature.

METHODS

Using the meta-ethnographic method, and following its seven canonical stages, a systematic search of databases was performed, informed by eMERGe guidelines.

FINDINGS

Thirty-three studies met the inclusion criteria. Reciprocal translation resulted in three third order constructs - 'influences and motivators', 'barriers and conflict and 'knowledge as empowerment'. Refutational translation resulted in one third order construct - 'the middle ground', which informed the line of argument synthesis and theoretical insights.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The findings of this review suggest that whilst existing literature from a range of high-income countries with similar healthcare systems to the UK have begun to explore non-normative decision-making for discrete episodes of care and choices, knowledge based, theoretical and population gaps exist in relation to understanding the experiences of, and wider social processes involved in, making non-normative choices across the UK maternity care continuum.

Women's reasons and motivations around planning a home birth with a qualified midwife in Spain

AIMS

The aim of this study was to describe and understand the reasons and motivations that lead a woman to choose home birth in Spain.

DESIGN

A qualitative study based on Gadamer's hermeneutic phenomenology was carried out.

METHODS

In-depth interviews were conducted with 24 women who had planned a home birth in the last year. The recruitment phase was carried out over a 3-week period during the month of March 2021. Inductive analysis was used to find themes based on the data obtained.

RESULTS

Four main themes emerged from the data analysis: (1) Women's home birth decision making, (2) Partner as the main support, (3) Need to prepare for childbirth and (4) Reasons for choosing home birth.

CONCLUSION

The women in this study spent a lot of time and dedication to choose the place where they would give birth. According to this research, decision making is influenced by multiple factors, both positive and negative, such as women's individual beliefs and values. The main reasons why women chose a home birth were the intimacy and security of the home, the accompaniment and the desire for a natural and free birth.

IMPACT

This study adds knowledge about the factors that influence the decision of women who choose home birth in Spain and the reasons and motivations that lead them to do so. In addition, it raises new questions about the satisfaction of women giving birth in the hospital as well as outside the hospital, and the quality of service provided by health professionals in the current Spanish public maternity system.

Women's perceptions of inclusion and exclusion criteria for publicly-funded homebirth - A survey

BACKGROUND

There are 15 publicly-funded homebirth programs in Australia. Women's access to these programs is determined by program specific inclusion and exclusion criteria.

AIMS

To examine women's perception of inclusion and exclusion criteria for publicly-funded homebirth programs in Australia and how these perceptions may influence women's choices and access to these programs.

METHODS

A national online survey was conducted and promoted through social media networks to women interested in homebirth in Australia. Quantitative data were analysed to generate descriptive statistics and a content analysis was performed on qualitative data.

FINDINGS

A total of 830 surveys were collected. Most women were supportive of inclusion and exclusion criteria related to social and environmental factors, although there was ambivalence about requiring ambulance cover, not having a history of domestic violence in the current relationship and requiring the woman to speak basic English. With regards to obstetric factors, only a requirement for labour to commence spontaneously at term was supported by over half of participants. All other obstetric related criteria had over half of participants disagreeing or strongly disagreeing that they should be used to prevent a woman from birthing at home. A desire for choice and access was frequently mentioned in the qualitative data.

CONCLUSION

There is a need to address the lack of choice many women experience when pregnant and the lack of equitable access to affordable homebirth services in Australia.

What influences rural women's choices in maternity care: A qualitative exploratory study

Rural women are likely to experience difficulties accessing maternity care that is readily available in metropolitan areas. This limited access can impede women's ability to make informed choices that enhance safety and minimize harm. This study explored the experiences of women who had given birth in a rural environment and the factors that influenced their choices regarding their maternity care. Semistructured interviews were conducted with 10 women for this qualitative, exploratory study. These women had birthed within rural areas of Victoria, Australia, between May 2016 and May 2017. Thematic analysis was undertaken. Three main themes emerged: (i) being influenced by previous childbirth experiences, (ii) feeling safe and supported with their maternity care provider, and (iii) being supported in their birthing choices. The availability of maternity care providers and travel time to facilities limited the choices of rural women. This study provided valuable insights into what was behind the decisions of rural women's choices regarding their maternity care. To assist with making informed decisions regarding their maternity care, all available models of maternity care should be presented to rural women.

Deciding on Home Birth

OBJECTIVE

To explore the decision-making processes of women who planned home births and to generate an emerging theoretical description of these processes.

DESIGN

Qualitative descriptive study using grounded theory.

SETTING

A certified nurse-midwifery home birth practice in a midsized city in the United States.

PARTICIPANTS

Eleven adult women who planned home births with certified nurse-midwives.

METHODS

We conducted semistructured, in-depth interviews with participants to discuss their decision-making processes regarding planning for their home births. Interviews were recorded and transcribed verbatim. We used open, selective, and theoretical coding and constant comparison to analyze the data.

RESULTS

The core category in the decision-making process regarding home birth was Claiming Maternal Space. The three main themes under this core category were Awareness of home birth, Movement from conventional perinatal care, and Shelter Building for labor and birth.

CONCLUSION

Our results suggest that women who plan home births greatly value agency during perinatal care. The core category Claiming Maternal Space represented how participants solved the problem of decreased agency in conventional perinatal care. Further research is needed to validate the emerging theoretical description and explore the association between agency and perinatal outcomes.