P22 - Negotiating the system: Women’s experiences of antenatal exclusion from publicly-funded homebirth

Abstract

Strict eligibility criteria for publicly-funded homebirth models mean that many women planning a homebirth are later excluded. At present, little is known about women’s experience of antenatal exclusion from these models. 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. The model has previously been positively evaluated by childbearing women and the midwives who work in them. This presentation will share findings from research exploring the experiences of women who planned a publicly-funded homebirth and were later excluded due to pregnancy complications or risk factors. This study employed a qualitative descriptive approach. Recruitment was via social media sites specifically related to homebirth in Australia. Data collection involved semi-structured telephone interviews with transcripts being thematically analysed by the research team. Thirteen women participated. Antenatal exclusion from a publicly-funded homebirth program can be distressing and women may wish to continue their plans to give birth at home. Some women feel coerced and bullied into following hospital protocols that are not tailored to their individual circumstances. Maintaining the midwife-mother relationship acts as a protective factor, ameliorating some of the negative effects caused by changing a woman’s planned place of birth. 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-mother relationship and assess risk on an individual basis. 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.