Abstract
Home birth is experienced by people very differently worldwide. These experiences likely differ by the type of stakeholder involved (women, their support persons, birth attendants, policy-makers), the experience itself (low-risk birth, transfer to hospital, previous deliveries), and by the health system within which home birth occurs (e.g., high-resource versus low- and middle-resource countries). Research evidence of stakeholders’ perspectives of home birth could usefully inform personal and policy decisions about choosing and providing home birth, but the current literature is fragmented and its breadth is not fully understood.We conducted a systematic scoping review to understand how the research literature on stakeholders’ perspectives of home birth is characterized in terms of populations, settings and identified issues, and what potential gaps exist in the research evidence. A range of electronic, web-based and key informant sources of evidence were searched. Located references were assessed, data extracted, and descriptively analyzed using robust methods.Our analysis included 460 full reports. Findings from 210 reports of studies in high-resource countries suggested that research with fathers and same-sex partners, midwives, and vulnerable populations and perspectives of freebirth and transfer to hospital could be synthesized. Gaps in primary research exist with respect to family members, policy makers, and those living in rural and remote locations. A further 250 reports of studies in low- and middle-resource countries suggested evidence for syntheses related to fathers and other family members, policy makers, and other health care providers and examination of issues related to emergency transfer to hospital, rural and remote home birth, and those who birth out of hospital, often at home, despite receiving antenatal care intended to increase healthcare-seeking behavior. Gaps in primary research suggest an examination is needed of perspectives in countries with higher maternal mortality and among first-time mothers and young mothers.Our scoping review identified a considerable body of research evidence on stakeholder perspectives of home birth. These could inform the complex factors influencing personal decisions and health system planning around home birth in both high- and low- and middle-resource countries. Future primary research is warranted on specific stakeholders worldwide and with vulnerable populations in areas of high maternal mortality.
Highlights
Rationale Childbirth is an important event for a woman and her family [1,2,3]
Very few studies reported whether the women planning or experiencing home birth were considered to be of low risk
A high number of studies conducted in low- and middleresource countries (LMRCs) focused on reasons for home birth despite access to health facilities
Summary
Rationale Childbirth is an important event for a woman and her family [1,2,3]. Birth takes place in many settingsBetween 1 and 16% of childbearing people in highresource countries (HRCs) choose to give birth at home, Brunton et al Syst Rev (2021) 10:291 where midwifery services are well-integrated into the health system model of care [9,10,11,12]. For women at low risk of complications, this integration of health system support for home birth in high-resource countries has been associated with maternal and newborn outcomes similar to those of women experiencing hospital delivery [15, 16]. In low-resource settings, the provision of safe home birth is complicated by multiple factors These include a lack of skilled birth attendants [21, 22]; access to, and quality of, care in obstetric facilities in the event of complications [6, 7]; pregnant women’s knowledge of complications [23, 24]; their cultural beliefs [25, 26]; and societal norms related to women’s autonomy [27]
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