Advertisement

Getting kicked off the program: Women’s experiences of antenatal exclusion from publicly-funded homebirth in Australia

      Abstract

      Problem

      Eligibility criteria for publicly-funded homebirth models are strict and, as such, many women who initially plan a homebirth later become excluded.

      Background

      Fifteen publicly-funded homebirth programs are operating in Australia, offering eligible women the opportunity to give birth at home at no cost, with the care of a hospital-employed midwife.

      Aim

      To explore the experiences of women who planned a publicly-funded homebirth and were later excluded due to pregnancy complications or risk factors.

      Methods

      A qualitative descriptive approach was taken. Recruitment was via social media sites specifically related to homebirth in Australia. Data collection involved semi-structured telephone interviews. Transcripts were thematically analysed.

      Findings

      Thirteen women participated. They were anxious about ‘Jumping through hoops’ to maintain their low-risk status. After being ‘Kicked off the program’, women carefully 'negotiated the system’ in order to get the birth they wanted in hospital. Some women felt bullied and coerced into complying with hospital protocols that did not account for their individual needs. Maintaining the midwife-woman relationship was a protective factor, decreasing negative experiences.

      Discussion

      Women plan a homebirth to avoid the medicalised hospital environment and to gain access to continuity of midwifery care. To provide maternity care that is acceptable to women, hospital institutions need to design services that enable continuity of the midwife-woman relationship and assess risk on an individual basis.

      Conclusion

      Exclusion from publicly-funded homebirth has the potential to negatively impact women who may feel a sense of loss, uncertainty or emotional distress related to their planned place of birth.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brocklehurst P.
        • Hardy P.
        • Hollowell J.
        • et al.
        Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.
        Br. Med. J. 2011; 343 (243-17)https://doi.org/10.1136/bmj.d7400
        • Davis D.
        • Baddock S.
        • Pairman S.
        • et al.
        Planned place of birth in New Zealand: does it affect mode of birth and intervention rates among low-risk women?.
        Birth. 2011; 38: 111-119https://doi.org/10.1111/j.1523-536X.2010.00458.x
        • de Jonge A.
        • Mesman J.A.J.M.
        • Manniën J.
        • Zwart J.J.
        • van Dillen J.
        • van Roosmalen J.
        Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study.
        Br. Med. J. 2013; 346 (e1001184-f3263)https://doi.org/10.1136/bmj.f3263
        • Hutton E.K.
        • Cappelletti A.
        • Reitsma A.H.
        • Simioni J.
        • Horne J.
        • McGregor C.
        • Ahmed R.J.
        Outcomes associated with planned place of birth among women with low-risk pregnancies.
        Can. Med. Assoc. J. 2016; 188: e80-e90https://doi.org/10.1503/cmaj.150564
        • Scarf V.L.
        • Rossiter C.
        • Vedam S.
        • et al.
        Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: a systematic review and meta-analysis.
        Midwifery. 2018; 62: 240-255https://doi.org/10.1016/j.midw.2018.03.024
        • Homer C.
        • Cheah S.L.
        • Rossiter C.
        • et al.
        Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: a linked population data study.
        BMJ Open. 2019; 9: 1-12https://doi.org/10.1136/bmjopen-2019-029192
        • Reitsma A.
        • Simioni J.
        • Brunton G.
        • Kaufman K.
        • Hutton E.K.
        Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: a systematic review and meta-analyses.
        EClinicalMedicine. 2020; 21100319https://doi.org/10.1016/j.eclinm.2020.100319
      1. Australian Institute of Health and Welfare. Australia's mothers and babies. 2021. Available from 〈https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies〉.

        • Catling-Paull C.
        • Foureur M.J.
        • Homer C.S.E.
        Publicly-funded homebirth models in Australia.
        Women Birth. 2012; 25: 152-158https://doi.org/10.1016/j.wombi.2011.10.003
        • Hunter J.
        • Dixon K.
        • Dahlen H.G.
        The experiences of privately practising midwives in Australia who have been reported to the Australian Health Practitioner Regulation Agency: a qualitative study.
        Women Birth. 2021; 34: e23-e31https://doi.org/10.1016/j.wombi.2020.07.008
      2. Thiele B., Thorogood C. Community Based Midwifery Program in Fremantle WA. Fremantle: Centre for Research for Women (WA) and the Fremantle Community Midwives. 1997.

      3. University of Technology Sydney. National publicly-funded homebirth consortium. 2021; Available at: 〈https://www.uts.edu.au/about/faculty-health/school-nursing-and-midwifery/centre-midwifery-child-and-family-health/research/past-projects/national-publicly-funded-homebirth〉. Accessed 8 December, 2021.

        • Jackson M.K.
        • Schmied V.
        • Dahlen H.G.
        Birthing outside the system: The motivation behind the choice to freebirth or have a homebirth with risk factors in Australia.
        BMC Pregnancy Childbirth. 2020; 20: 254https://doi.org/10.1186/s12884-020-02944-6
        • Blums T.
        • Donnellan-Fernandez R.
        • Sweet L.
        Inclusion and exclusion criteria for publicly-funded homebirth in Australia: a scoping review.
        Women Birth. 2021; https://doi.org/10.1016/j.wombi.2021.01.009
        • Roome S.
        • Hartz D.
        • Tracy S.
        • Welsh A.W.
        Why such differing stances? A review of position statements on home birth from professional colleges.
        BJOG. 2016; 123: 376-382https://doi.org/10.1111/1471-0528.13594
      4. Australian College of Midwives. National Midwifery Guidelines for Consultation and Referral. 4th ed.; 2021.

        • Catling‐Paull C.
        • Coddington R.L.
        • Foureur M.J.
        • Homer C.S.E.
        Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years.
        Med. J. Aust. 2013; 198: 616-620https://doi.org/10.5694/mja12.11665
        • Catling-Paull C.
        • Dahlen H.
        • Homer
        • Caroline C.S.E.
        Multiparous women’s confidence to have a publicly-funded homebirth: a qualitative study.
        Women Birth. 2011; 24: 122-128https://doi.org/10.1016/j.wombi.2010.09.001
        • Coddington R.
        • Catling C.
        • Homer C.
        Seeing birth in a new light: the transformational effect of exposure to homebirth for hospital-based midwives.
        Midwifery. 2020; 88102755https://doi.org/10.1016/j.midw.2020.102755
        • Forster D.A.
        • McKay H.
        • Davey M.
        • et al.
        Women’s views and experiences of publicly-funded homebirth programs in Victoria, Australia: a cross-sectional survey.
        Women Birth. 2019; 32: 221-230https://doi.org/10.1016/j.wombi.2018.07.019
        • Blums T.
        • Donnellan-Fernandez R.
        • Sweet L.
        Women’s perceptions of inclusion and exclusion criteria for publicly-funded homebirth — A survey.
        Women Birth. 2021; https://doi.org/10.1016/j.wombi.2021.08.007
        • Fox D.
        • Sheehan A.
        • Homer C.
        Birthplace in Australia: processes and interactions during the intrapartum transfer of women from planned homebirth to hospital.
        Midwifery. 2018; 57: 18-25https://doi.org/10.1016/j.midw.2017.10.022
        • Coddington R.
        • Catling C.
        • Homer C.S.E.
        From hospital to home: Australian midwives’ experiences of transitioning into publicly-funded homebirth programs.
        Women Birth. 2017; 30: 70-76https://doi.org/10.1016/j.wombi.2016.08.001
        • McLachlan H.
        • McKay H.
        • Powell R.
        • et al.
        Publicly-funded home birth in Victoria, Australia: exploring the views and experiences of midwives and doctors.
        Midwifery. 2016; 35: 24-30https://doi.org/10.1016/j.midw.2016.02.004
        • Scarf V.L.
        • Yu S.
        • Viney R.
        • et al.
        Modelling the cost of place of birth: a pathway analysis.
        BMC Health Serv. Res. 2021; 21: 1-816https://doi.org/10.1186/s12913-021-06810-9
        • Sandelowski M.
        What’s in a name? Qualitative description revisited.
        Res. Nurs. Health. 2010; 33: 77-84https://doi.org/10.1002/nur.20362
        • Bradshaw C.
        • Atkinson S.
        • Doody O.
        Employing a qualitative description approach in health care research.
        Glob. Qual. Nurs. Res. 2017; 42333393617742282https://doi.org/10.1177/2333393617742282
        • Burns E.
        • Fenwick J.
        • Schmied V.
        • Sheehan A.
        Reflexivity in midwifery research: The insider/outsider debate.
        Midwifery. 2012; 28: 52-60https://doi.org/10.1016/j.midw.2010.10.018
        • Dodgson J.E.
        Reflexivity in qualitative research.
        J. Hum. Lact. 2019; 35: 220-222https://doi.org/10.1177/0890334419830990
        • Cachia M.
        • Millward L.
        The telephone medium and semi-structured interviews: a complementary fit.
        Qual. Res. Organ. Manag. 2011; 6: 265-277https://doi.org/10.1108/17465641111188420
        • Novick G.
        Is there a bias against telephone interviews in qualitative research?.
        Res. Nurs. Health. 2008; 31: 391-398https://doi.org/10.1002/nur.20259
        • Minichiello V.
        • Aroni R.
        • Hays T.
        In-depth Interviewing: Principles, Techniques, Analysis. 3rd ed. Pearson Australia Group, Australia2008
        • Braun V.
        • Clarke V.
        What can “thematic analysis” offer health and wellbeing researchers?.
        Int. J. Qual. Stud. Health Well-being. 2014; 9: 26152https://doi.org/10.3402/qhw.v9.26152
        • Sassine H.
        • Burns E.
        • Ormsby S.
        • Dahlen H.G.
        Why do women choose homebirth in Australia? A national survey.
        Women Birth. 2021; 34: 396-404https://doi.org/10.1016/j.wombi.2020.06.005
        • Rigg E.C.
        • Schmied V.
        • Peters K.
        • Dahlen H.G.
        Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study.
        BMC Pregnancy Childbirth. 2017; 17: 99https://doi.org/10.1186/s12884-017-1281-0
        • Reed R.
        • Sharman R.
        • Inglis C.
        Women's descriptions of childbirth trauma relating to care provider actions and interactions.
        BMC Pregnancy Childbirth. 2017; 17: 21https://doi.org/10.1186/s12884-016-1197-0
        • Lane K.
        • Reiger K.
        Regime change in Australian maternity hospitals.
        Soc. Theory Health. 2013; 11: 407-427https://doi.org/10.1057/sth.2013.7
        • Hunter B.
        • Berg M.
        • Lundgren I.
        • Ólafsdóttir Ó.Á.
        • Kirkham M.
        Relationships: the hidden threads in the tapestry of maternity care.
        Midwifery. 2008; 24: 132-137https://doi.org/10.1016/j.midw.2008.02.003
        • Homer C.S.E.
        Models of maternity care: evidence for midwifery continuity of care.
        Med J. Aust. 2016; 205: 370-374https://doi.org/10.5694/mja16.00844
        • Lundgren I.
        • Berg M.
        Central concepts in the midwife-woman relationship.
        Scand. J. Caring Sci. 2007; 21: 220-228https://doi.org/10.1111/j.1471-6712.2007.00460.x
        • Perriman N.
        • Davis D.L.
        • Ferguson S.
        What women value in the midwifery continuity of care model: a systematic review with meta-synthesis.
        Midwifery. 2018; 62: 220-229https://doi.org/10.1016/j.midw.2018.04.011
        • Fox D.
        • Sheehan A.
        • Homer C.
        Experiences of women planning a home birth who require intrapartum transfer to hospital: a metasynthesis of the qualitative literature.
        Int. J. Childbirth. 2014; 4: 103-119https://doi.org/10.1891/2156-5287.4.2.103
      5. World Health Organization, International Conference on Primary Health Care Declaration of Alma-Ata, 1978. Available at: 〈http://www.who.int/publications/almaata_declaration_en.pdf〉.

        • Renfrew M.J.
        • Mcfadden A.
        • Bastos M.H.
        • et al.
        Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.
        Lancet. 2014; 384: 1129-1145https://doi.org/10.1016/S0140-6736(14)60789-3
        • Romanis E.C.
        • Nelson A.
        Homebirthing in the United Kingdom during COVID-19.
        Med. Law Int. 2020; 20: 183-200https://doi.org/10.1177/0968533220955224