Abstract
BackgroundEvidence suggests that home birth is as safe as hospital birth for low risk multiparous women, and is associated with reduced intervention rates and increased rates of normal birth. However the home birth rate in the UK is low, and few women choose this option. The aims of this study were to identify what influences multiparous women’s choice of birth place, and to explore their views of home birth.MethodsFive focus groups were conducted with multiparous women (n = 28) attending mother and baby groups in a city in the UK with a diverse multi-ethnic population. Data were analysed thematically using the Framework Method, combining deductive and inductive approaches to the data.ResultsSeveral themes were developed from the data, these were: the expectation that birth would take place in an Obstetric Unit; perceptions of birth as a ‘natural’ event; lack of knowledge of what home birth looked like; and a lack of confidence in the reliability of the maternity service. Two themes emerged regarding the influences on women’s choices: clear information provision, particularly for those from ethnic minority groups, and the role of health care professionals. A final theme concerned women’s responses to the offer of choice.ConclusionsThere are gaps in women’s knowledge about the reality and practicalities of giving birth at home that have not been previously identified. Other findings are consistent with existing evidence, suggesting that many women still do not receive consistent, comprehensive information about home birth. The findings from this research can be used to develop approaches to meet women’s information and support needs, and facilitate genuine choice of place of birth.
Highlights
Recent evidence suggests that home birth is as safe as hospital birth for low risk multiparous women, and that planned birth at home is associated with reduced intervention rates and increased rates of normal birth [1,2,3,4,5]
The recent National Maternity Review in England recommended that women are offered a genuine choice of birth place options [8], and the National Institute for Health and Care Excellence in the UK recommends that home birth is offered as an option to multiparous women at low risk of complications [1]
What does home birth look like? For many participants, home birth was an unfamiliar concept. If they did consider it as an option it appeared they had little knowledge on which to base an informed choice: ‘I don’t even know if you have a home birth where do you give birth? Do you choose a room; do you...in a bed? I’ve got absolutely no idea’ Participant 4, 32, Low risk (LR)’
Summary
Evidence suggests that home birth is as safe as hospital birth for low risk multiparous women, and is associated with reduced intervention rates and increased rates of normal birth. Recent evidence suggests that home birth is as safe as hospital birth for low risk multiparous women, and that planned birth at home is associated with reduced intervention rates and increased rates of normal birth [1,2,3,4,5]. A recent evidence review synthesised the findings from 20 studies to determine what is known about women’s birth place preferences and decision-making in the UK [16] It found the key influences on women’s decisions about place of birth included: receipt of information about the right to choose birth place, and the options available; personal preferences for different services; beliefs about safety and risk; prior birth experience; and information provided by family, friends and healthcare professionals. The evidence synthesis was undertaken subsequent to the empirical work presented in this paper, and while many of the findings align, this study has elicited novel findings regarding women’s awareness of what home birth involves, and the extent to which health services meet their? information needs
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