Concerns of Women Choosing Community Birth During the COVID‐19 Pandemic: A Qualitative Study

Abstract

Introduction During the coronavirus disease 2019 (COVID‐19) pandemic, midwives have reported increased demand for community birth services. The purpose of this qualitative study was to understand childbearing persons’ decision‐making during the pandemic and to illuminate their experiences giving birth in community settings. Methods The study was framed by the interpretive phenomenological approach. Eligible participants were recruited from midwives providing out‐of‐hospital birth services. Of the 26 women who agreed to an interview, 17 were able to be reached and interviewed. Interviews followed a semistructured guide. Early paradigm cases were coded by all researchers, and then the first author coded the remaining transcripts. The final thematic structure was developed by the research team through an iterative process and validated through member checking. Results Four themes were identified: prior desire for a community birth, perceived susceptibility, barriers to choice, and isolation. Discussion Many participants had a preexisting desire for community birth and used the pandemic to justify their choice. However, birth options were often limited by finances and geography. Attitude toward COVID‐19 varied by knowledge and experience. Many participants experienced stress and isolation.

United States community births increased by 20% from 2019 to 2020

“…33,34 As DeJoy et al noted in their study of community birth during the pandemic, many respondents had a preexisting interest in community birth and the pandemic reinforced their choice. 35 The COVID pandemic also created a less supportive environment for hospital birth as many hospitals established policies limiting access to maternity floors for support persons, including partners and doulas. 3,36 Preexisting concerns with hospital maternity environments 32 were exacerbated by the pandemic, combined with the more developed systems of community care, propelled the major increase reported here.…”

“…Growing concern with the quality and respectfulness of care women reported receiving in hospitals 32 has renewed interest in alternatives to the existing medical model of maternity care 33,34 . As DeJoy et al noted in their study of community birth during the pandemic, many respondents had a pre‐existing interest in community birth and the pandemic reinforced their choice 35 . The COVID pandemic also created a less supportive environment for hospital birth as many hospitals established policies limiting access to maternity floors for support persons, including partners and doulas 3,36 .…”

Policies and Practices on Out-of-Hospital Birth: a Review of Qualitative Studies in the Time of Coronavirus

“…The studies included in this review show the perspective and experience of women regarding home birth during the COVID-19 pandemic [ 11 – 24 , 25 •, 26 – 35 ]. A few case protocols or policies are also discussed [ 17 , 19 , 25 •, 34 ]. In the qualitative synthesis, the following themes emerged as significative during the pandemic: (1) increased use of and interest in homebirth and independent birth centers by pregnant women (16 studies); (2) midwives’ perceptions and role (10 studies); (3) reasons of the preference of giving birth in an out-of-hospital setting (17 studies); (4) women’s experiences (10 studies); (5) barriers to access a no hospitalized birth (9 studies); (6) recommendations (12 studies).…”

“…In Croatia during the pandemic period, the overall prevalence of unplanned out-of-hospital births was 0.4%, against the annual out-of-hospital birth rate reported in the last decade, consistently around 0.05–0.10% of all singleton gestations [ 17 ]. Midwives’ perspectives and experiences The perceptions of community midwives and midwives working in hospital-based care regarding the increasing birth rate in their country are reported [ 16 , 19 , 21 , 24 ]. Midwives also reported increased interest in or desire for out-of-hospital birth, increase in the number of enquiries by women relating to homebirth, more confidence in giving birth at home, and better-informed choices about the place of birth [ 16 , 19 , 21 , 24 ].…”

“… Midwives’ perspectives and experiences The perceptions of community midwives and midwives working in hospital-based care regarding the increasing birth rate in their country are reported [ 16 , 19 , 21 , 24 ]. Midwives also reported increased interest in or desire for out-of-hospital birth, increase in the number of enquiries by women relating to homebirth, more confidence in giving birth at home, and better-informed choices about the place of birth [ 16 , 19 , 21 , 24 ]. Women with high-risk pregnancies, such as those living with HIV, are increasingly investigating the option of home birth, according to the midwives’ experiences [ 24 ].…”