Home birth experience 1: decision and expectation

BackgroundCurrent clinical guidelines and national policy in England support offering ‘low risk’ women a choice of birth setting. Options include: home, free-standing midwifery unit (FMU), alongside midwifery unit (AMU) or obstetric unit (OU). This study, which is part of a broader project designed to inform policy on ‘choice’ in relation to childbirth, aimed to provide evidence on UK women’s experiences of choice and decision-making in the period since the publication of the Birthplace findings (2011) and new NICE guidelines (2014). This paper reports on findings relating to women’s information needs when making decisions about where to give birth.MethodsA qualitative focus group study including 69 women in the last trimester of pregnancy in England in 2015–16. Seven focus groups were conducted online via a bespoke web portal, and one was face-to-face. To explore different aspects of women’s experience, each group included women with specific characteristics or options; planning a home birth, living in areas with lots of choice, living in areas with limited choice, first time mothers, living close to a FMU, living in opt-out AMU areas, living in socioeconomically disadvantaged areas and planning to give birth in an OU. Focus group transcripts were analysed thematically.ResultsWomen drew on multiple sources when making choices about where to give birth. Sources included; the Internet, friends’ recommendations and experiences, antenatal classes and their own personal experiences. Their midwife was not the main source of information. Women wanted the option to discuss and consider their birth preferences throughout their pregnancy, not at a fixed point.ConclusionsBirthplace choice is informed by many factors. Women may encounter fewer overt obstacles to exercising choice than in the past, but women do not consistently receive information about birthplace options from their midwife at a time and in a manner that they find helpful. Introducing options early in pregnancy, but deferring decision-making about birthplace until a woman has had time to consider and explore options and discuss these with her midwife, might facilitate choice.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1601-4) contains supplementary material, which is available to authorized users.

Section: Discussionmentioning

confidence: 59%

Birthplace choices: what are the information needs of women when choosing where to give birth in England? A qualitative study using online and face to face focus groups

Hinton

Dumelow

Rowe

et al. 2018

“…Reflexivity and explanation of data analysis were the items most often lacking sufficient detail [28, 33–36]. …”

Section: Resultsmentioning

confidence: 99%

“…Within this context, women described that clinicians, friends and family might oppose planned home birth [10, 32], explained that they needed positive support from their partners to achieve home birth [33, 38, 43] and that they felt ultimately responsible for this decision and any consequences [9, 37]. …”

Section: Resultsmentioning

confidence: 99%

What influences birth place preferences, choices and decision-making amongst healthy women with straightforward pregnancies in the UK? A qualitative evidence synthesis using a ‘best fit’ framework approach

Coxon

Chisholm

Malouf

et al. 2017

BackgroundEnglish maternity care policy has supported offering women choice of birth setting for over twenty years, but only 13% of women in England currently give birth in settings other than obstetric units (OUs). It is unclear why uptake of non-OU settings for birth remains relatively low. This paper presents a synthesis of qualitative evidence which explores influences on women’s experiences of birth place choice, preference and decision-making from the perspectives of women using maternity services.MethodsQualitative evidence synthesis of UK research published January 1992-March 2015, using a ‘best-fit’ framework approach. Searches were run in seven electronic data bases applying a comprehensive search strategy. Thematic framework analysis was used to synthesise extracted data from included studies.ResultsTwenty-four papers drawing on twenty studies met the inclusion criteria. The synthesis identified support for the key framework themes. Women’s experiences of choosing or deciding where to give birth were influenced by whether they received information about available options and about the right to choose, women’s preferences for different services and their attributes, previous birth experiences, views of family, friends and health care professionals and women’s beliefs about risk and safety. The synthesis additionally identified that women’s access to choice of place of birth during the antenatal period varied. Planning to give birth in OU was straightforward, but although women considering birth in a setting other than hospital OU were sometimes well-supported, they also encountered obstacles and described needing to ‘counter the negativity’ surrounding home birth or birth in midwife-led settings.ConclusionsOver the period covered by the review, it was straightforward for low risk women to opt for hospital birth in the UK. Accessing home birth was more complex and contested. The evidence on freestanding midwifery units (FMUs) is more limited, but suggests that women wanting to opt for an FMU birth experienced similar barriers. The extent to which women experienced similar problems accessing alongside midwifery units (AMUs) is unclear.Women’s preferences for different birth options, particularly for ‘hospital’ vs non-hospital settings, are shaped by their pre-existing values, beliefs and experience, and not all women are open to all birth settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1279-7) contains supplementary material, which is available to authorized users.

“…[ 21 , 29 ] The literature and this study also describe the negative influence that professionals can have on facilitating genuine choice for women when considering place of birth. [ 16 , 25 , 32 , 33 ] Professionals’ attitudes have been observed to influence women’s choices and behaviours elsewhere in maternity care. Dominant cultural norms can restrict the choices offered to women in prenatal testing.…”

Section: Discussionmentioning

confidence: 99%

‘I didn’t think you were allowed that, they didn’t mention that.’ A qualitative study exploring women’s perceptions of home birth

Smith¹,

Taylor

Shaw

et al. 2018

BackgroundEvidence suggests that home birth is as safe as hospital birth for low risk multiparous women, and is associated with reduced intervention rates and increased rates of normal birth. However the home birth rate in the UK is low, and few women choose this option. The aims of this study were to identify what influences multiparous women’s choice of birth place, and to explore their views of home birth.MethodsFive focus groups were conducted with multiparous women (n = 28) attending mother and baby groups in a city in the UK with a diverse multi-ethnic population. Data were analysed thematically using the Framework Method, combining deductive and inductive approaches to the data.ResultsSeveral themes were developed from the data, these were: the expectation that birth would take place in an Obstetric Unit; perceptions of birth as a ‘natural’ event; lack of knowledge of what home birth looked like; and a lack of confidence in the reliability of the maternity service. Two themes emerged regarding the influences on women’s choices: clear information provision, particularly for those from ethnic minority groups, and the role of health care professionals. A final theme concerned women’s responses to the offer of choice.ConclusionsThere are gaps in women’s knowledge about the reality and practicalities of giving birth at home that have not been previously identified. Other findings are consistent with existing evidence, suggesting that many women still do not receive consistent, comprehensive information about home birth. The findings from this research can be used to develop approaches to meet women’s information and support needs, and facilitate genuine choice of place of birth.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1733-1) contains supplementary material, which is available to authorized users.