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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2017

Open Access 01-12-2017 | Research article

Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study

Authors: Elizabeth Christine Rigg, Virginia Schmied, Kath Peters, Hannah Grace Dahlen

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

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Abstract

Background

In Australia the choice to birth at home is not well supported and only 0.4% of women give birth at home with a registered midwife. Recent changes to regulatory requirements for midwives have become more restrictive and there is no insurance product that covers private midwives for intrapartum care at home. Freebirth (planned birth at home with no registered health professional) with an unregulated birth worker who is not a registered midwife or doctor (e.g. Doula, ex-midwife, lay midwife etc.) appears to have increased in Australia. The aim of this study is to explore the reasons why women choose to give birth at home with an unregulated birth worker (UBW) from the perspective of women and UBWs.

Methods

Nine participants (five women who had UBWs at their birth and four UBWs who had themselves used UBWs in the past for their births) were interviewed in-depth and the data analysed using thematic analysis.

Results

Four themes were found: ‘A traumatising system’, ‘An inflexible system’; ‘Getting the best of both worlds’ and ‘Treated with love and respect versus the mechanical arm on the car assembly line’. Women interviewed for this study either experienced or were exposed to mainstream care, which they found traumatising. They were not able to access their preferred birth choices, which caused them to perceive the system as inflexible. They interpreted this as having no choice when choice was important to them. The motivation then became to seek alternative options of care that would more appropriately meet their needs, and help avoid repeated trauma through mainstream care.

Conclusion

Women who engaged UBWs viewed them as providing the best of both worlds – this was birthing at home with a knowledgeable person who was unconstrained by rules or regulations and who respected and supported the woman’s philosophical view of birth. Women perceived UBWs as not only the best opportunity to achieve a natural birth but also as providing ‘a safety net’ in case access to emergency care was required.
Literature
1.
2.
Commonwealth of Australia. Improving Maternity Services in Australia: A discussion paper from the Australian Government. In.; 2008.
3.
Dahlen H, Schmied V, Tracy SK, Jackson M, Cummings J, Priddis H. Home birth and the National Australian Maternity Services Review: too hot to handle? Women Birth. 2011;24(4):148–55.CrossRefPubMed
4.
5.
Bryant R. Improving Maternity Services in Australia: The Report of the Maternity Services Review. In.; 2009.
6.
Jackson M, Dahlen H, Schmied V. Birthing outside the system: perceptions of risk amongst Australian women who have freebirths and high risk homebirths. Midwifery. 2012;28(5):561–7.CrossRefPubMed
7.
Schapel AE. Findings of Inquest. In. Edited by Coroner. South Australia: Government of South Australia; 2012.
8.
Rigg E, Schmied V, Peters K, Dahlen H. Not addressing the root cause: An analysis of submissions made to the South Australian Government on a Proposal to Protect Midwifery Practice. Women Birth. 2015. doi:10.​1016/​j.​wombi.​2014.​12.​005.
9.
Hilder L, Zhichao Z, Parker M, Jahan SCGM. Australia’s mothers and babies 2012. Report. 2014, Cat. no. PER 69(30).
10.
11.
Puddy R. Risky Delivery: Hospital vs Home: should mothers always have the right to choose where they give birth?.In: Weekend Australian ID 15299563 edn. Weekend Australian Magazine: Copyright Agency Ltd; 2012: 10.
12.
PricewaterhouseCoopers. Professional indemnity insurance for midwives research. Victoria, Australia: Nursing and Midwifery Board of Australia; 2013. p. 1–108.
13.
Government of South Australia. Proposal to Protect Midwifery Practice in South Australia: Consultation paper. Edited by Australia GoS; 2013: 1-12.
14.
Teddlie C, Tashakkori A. Foundations of Mixed Methods Research: Integrating Qualitative and Quantitive Approaches in the Social and Behavioral Sciences. United States of America: SAGE Publicaitons, Inc; 2009.
15.
Stewart M, Hunt SC. Pregnancy, Birth and Maternity Care Feminist Perspectives. London: Elsevier Butterworth Heinemann; 2005.
16.
Kourany JA, Sterba JP, Tong R. Femanist philosophies: problems theories and applications. New Hersey: Prentice Hall; 1992.
17.
Stewart M, Hunt SC. Pregnancy, birth and maternity care: feminist perspective.Edinburgh: Books for Midwives; 2004.
18.
Elmer R, Schmied V, Jackson D, Wilkes L. Interviewing people about potentially sensitive topics. Nurse Res. 2011;12(1):12–6.CrossRef
19.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
20.
Liamputtong P. Research methods in health: foundations for evidence-based practice. Melbourne, Australia: Oxford University Press; 2013.
21.
Alley S, Jackson SF, Shakya YB. Reflexivity: a methodological tool in the knowledge translation process? Health Promot Pract. 2015;16(3):426–31.CrossRefPubMed
22.
Schippers MC, Den Hartog DN, Koopman PL. Reflexivity in teams: a measure and correlates. Appl Psychol. 2007;56(2):189–211.CrossRef
23.
Dahlen HG, Tracy S, Tracy M, Bisits A, Brown C, Thornton C. Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open. 2012;2:5.CrossRef
24.
Hyde M, Mostyn A, Modi N, Kemp P. The health implications of birth by Caesarean section. Biol Rev. 2011;87(1):229–43.CrossRefPubMed
25.
Clark EA, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol. 2011;205(6 Suppl):S2–S10.CrossRefPubMed
26.
Creedy DK, Shochet IM, Horsfall J. Childbirth and the Development of Acute Trauma Symptoms- Incidence and Contributing Factors. Birth. 2000;27(2):104–11.CrossRefPubMed
27.
Australia ACoMS. Submission from the Australian College of Midwives on: The Proposal to Protect Midwifery Practice in South Australia. 2013:1.
28.
Dahlen HG, Jackson M, Stevens J. Homebirth, freebirth and doulas: casualty and consequences of a broken maternity system. Women Birth. 2011;24(1):47–50.CrossRefPubMed
29.
Hodnett ED, Gates S, Dofmeyr GJ, Weston J. Continuous support for women during childbirth (Review). Cochrane Database Syst Rev. 2012;10:1–113.
30.
Meares M. Submission to the South Australian Department of Health Proposal to Protect Midwifery Practice. South Australia: Submission to South Australian Govermnent. 2013:1–7.
31.
Keedle H, Schmied V, Burns E, Dahlen HG. Women's reasons for, and experiences of, choosing a homebirth following a caesarean section. BMC Pregnancy Childbirth. 2015;15:206.CrossRefPubMedPubMedCentral
32.
Beck TC. Birth Trauma In the Eye of the Beholder. Nurs Res. 2004a;53(1):28.
33.
s WHO. The prevention and elimination of disrespect and abuse during facility-based childbirth. 2015. p. 1–3.
34.
Hackett L. “No control and no way out” -an exploration of birth trauma and its effects. 2014. p. 1–54.
35.
Harris R, Ayers S. What makes labour and birth traumatic? a survey of intrapartum ‘hotspots’. Psychol Health. 2012;27(10):1166–77.CrossRefPubMed
36.
Haraway DJ. Simians, Cyborgs and Women: The Reinventation of nature. 1991. p. 1–277.
37.
Newnham E. Birth control: Power/knowledge in the politics of birth. Health Sociol Rev. 2015;23(3):254–68.CrossRef
38.
MacCall M. The birth wars. St Lucia, QLD. University of Queensland Presss; 2009.
39.
Reiger K, Dempsey R. Performing birth in a culture of fear: an embodied crisis of late modernity. Health Sociol Rev. 2014;15(4):364–73.CrossRef
40.
Skerman JK. A minority report: Homebirth in Australia before and after the 2009 Maternity Services Review. J Law Med. 2013;21:142–58.PubMed
41.
Dahlen H. Pushing home birth underground raises safety concerns. The Conversation. Online; 2012
42.
Robson S. International Statements: Homebirth. Brief summaries of applicable statements concerning homebirth from interested organisations in English-speaking countries are presented below, together with a commentary. 2011;13(4).
43.
44.
Barclay L, Tracy SK. Legally binding midwives to doctors is not collaboration. Women Birth. 2010;23(1):1–2.CrossRefPubMed
45.
Lane K. When is collaboration not collaboration? When it's militarized. Women Birth. 2012;25(1):29–38.CrossRefPubMed
46.
47.
Dahlen H, Jackson M, Schmied V, Tracy S, Priddis H. Birth centres and the national maternity services review: response to consumer demand or compromise? Women Birth. 2011;24(4):165–72.CrossRefPubMed
48.
Safety and Quality Guidelines for Privately Practising Midwives, Nursing and Midwifery Board of Australia. 2015:1-5. Accessed 1 Jan 2017.
49.
50.
Khaskheli MN, Baloch S, Sheeba A. Iatrogenic risks and maternal health: Issues and outcomes. Pak J Med Sci. 2014;30(1):111–5.PubMedPubMedCentral
51.
52.
DiMatteo MR, Kahn KL, Berry SH. Narratives of birth and the postpartum:analysis of the focus group responces of new mothers. Birth. 1993;20(4):204–11.CrossRefPubMed
53.
Ayers S, McKenzie-McHarg K, Slade P. Post-traumatic stress disorder after birth. J Reprod Infant Psychol. 2015;33(3):215–8.CrossRef
54.
Beck CT. Post traumatic stress disorder due to child- birth- The aftermath. Nurs Res. 2004b;53(4):216-224.
55.
Verreault N, Da Costa D, Marchand A, Ireland K, Banack H, Dritsa M, Khalife S. PTSD following childbirth: a prospective study of incidence and risk factors in Canadian women. J Psychosom Res. 2012;73(4):257–63.CrossRefPubMed
56.
Lapp LK, Agbokou C, Peretti CS, Ferreri F. Management of post traumatic stress disorder after childbirth: a review. J Psychosom Obstet Gynaecol. 2010;31(3):113–22.CrossRefPubMed
57.
McKenzie-McHarg K, Ayers S, Ford E, Horsch A, Jomeen J, Sawyer A, Stramrood C, Thomson G, Slade P. Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research. J Reprod Infant Psychol. 2015;33(3):219–37.CrossRef
58.
Garthus-Niegel S, von Soest T, Vollrath ME, Eberhard-Gran M. The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study. Arch Womens Ment Health. 2013;16(1):1–10.CrossRefPubMed
59.
Toohill J, Fenwick J, Gamble J, Creedy DK. Prevalence of childbirth fear in an Australian sample of pregnant women. BMC Pregnancy Childbirth. 2014;14:275.CrossRefPubMedPubMedCentral
60.
Nursing and Midwifery Board of Australia. Nursing and midwifery regulation at work in Australia: Managing the risk to the public, Regulating nurses and midwives. Canberra: AHPRA. 2015:25.
61.
Australian Nursing and Midwifey Accreditation Council (ANMAC). Midwife Accreditation Standards 2014. Canberra: ANMAC; 2014. p. 35.
62.
Nursing and Midwifery Board of Australia. Nursing and Midwifery Board Registration Standard Professional Indemnity Insurance-Arrangements. Australia Nursing and Midwifery Board of Austrlia 2016: 5.
63.
Nursing and Midwifery Board of Australia (NMBA). A midwive's guide to professional boundaries. Melbourne: Nursing and Midwifery Board of Australia (NMBA); 2010.
64.
O'Boyle C. The Context and Consequences of Professional Indemnification of Home Birth Midwifery in Ireland. Int J Childbirth. 2014;4(1):39–54.CrossRef
65.
Reiger KM. “Knights” or “Knaves”? Public policy, professional power, and reforming maternity services. Health Care Women Int. 2011;32(1):2–22.CrossRefPubMed
66.
Nursing and Midwifery Board of Australia. National Competency Standards for the Midwife. Melbourne: Nursing and Midwifery Board of Australia; 2006.
67.
National Health and Medical Research Council (NHMRC). National Guidance on Collaborative Maternity Care. Practice Guide. 2010;1-47.
68.
Government SA. Health Practitioner Regulation National Law (South Australia) (Restricted Practices) Amendment Bill 2013. 2013
69.
South Australian Government. HPRNL SA restriction of practice amended. In: No 26of 2013 assented to 21112013. South Australia: South Australian Government; 2013. p. 1–3.
70.
Government of South Australia. Proposal to Protect Midwifery Practice in South Australia: Consultation Paper. South Australia; Government of South Australia, SA Health; 2012.
71.
72.
73.
Metadata
Title
Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study
Authors
Elizabeth Christine Rigg
Virginia Schmied
Kath Peters
Hannah Grace Dahlen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-017-1281-0

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