A survey of women in Australia who choose the care of unregulated birthworkers for a birth at home.

BACKGROUND: Anecdotally, the number of Australian women who choose unregulated birthworkers to support a homebirth without a registered midwife present is increasing. AIM: To explore the experiences and reasons why some women choose unregulated birthworkers for a homebirth, and examine what they might do if changes in legislation removed this choice. METHODS: A survey was distributed via social media networks and data were analysed using descriptive statistics. Content analysis was undertaken on open-ended questions. FINDINGS: Eighty-two women completed the survey. Most reported they achieved an undisturbed homebirth with a flexible carer who provided continuity of care and respect for their choices irrespective of risk factors. Three women whose babies died described their homebirth with an unregulated birthworker as the worst experience of their life. Motivators for choosing an unregulated birthworker to support homebirth were: previous negative and traumatising birth experiences; limited choice; and lack of access to midwifery led models of care within mainstream services. Only a third of the women in this study said they would birth in a hospital if legislation prevented their access to an unregulated birthworker's support for a future birth. CONCLUSION: Maternity services in Australia do not meet all women's needs, leaving some feeling no other option exists but to seek an unregulated birthworker to support a homebirth. Previous negative experiences with maternity healthcare providers, inflexible systems of care, and limited access to funding for homebirth with privately practising midwives were identified as motivating factors. These issues require solutions to prevent homebirth going underground.

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

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.