Abstract
BackgroundAbout 1.6% of planned births in the United States occur out of hospitals. Studies indicate that planned out-of-hospital birth (OOHB) is safe and satisfying for women; however, there is great variation among ethnic groups, and Black women are underrepresented. A recent phenomenon is the choice to have an unassisted birth (UAB) with no midwife or other professional maternity care attendant. The purpose of this study is to fill a gap in understanding reasons for choosing OOHB or UAB for two clinically important sub-groups of women: Black women, and women who have experienced childhood physical or sexual abuse.MethodsThis study recruited 18 women who had an OOHB or UAB and who identified as either Black or survivors of trauma to participate in in-depth qualitative interviews concerning their choice to give birth out of hospital. A grounded theory approach was utilized that involved a discursive process of data collection, coding textual passages to identify focused themes, memo writing to document analytic decision-making, and eventual conceptual modeling.ResultsAll 18 participants endorsed a history of trauma. Focused coding to identify inherent concepts led to the emergence of a theoretical model of the arc of decision-making around choice of place of birth and birth attendant, or lack thereof. Women may choose OOHB or UAB because of a previous trauma, or because they feel discriminated against by healthcare professionals, either because of skin color, age, pregnancy, weight, or some other health condition. Women may choose OOHB or UAB because it affords more control during the process of giving birth.ConclusionPrevious trauma and experiences of discrimination were influential factors for women in the study sample in their choice of birthplace setting and choice of provider. These findings can inform clinical understanding for birth professionals, including doctors, midwives, doulas, nurses, social workers, and psychologists, and contributes more broadly to the national conversation about birth choices in the USA.
Highlights
About 1.6% of births in the United States are “community births” that occur out of hospitals, including births in a residence, freestanding birth center, clinic, doctor’s office, or other location [1]
Previous studies show that women who have experienced childhood physical or sexual abuse may prioritize having a sense of control and autonomy during their birthing
Our study recruited 18 women who had an out-of-hospital birth (OOHB) or unassisted birth (UAB) and who identified as either Black and/or survivors of trauma to participate in in-depth interviews concerning their choice to give birth out of hospital
Summary
About 1.6% of births in the United States are “community births” that occur out of hospitals, including births in a residence (i.e., home births), freestanding birth center, clinic, doctor’s office, or other location [1]. More unassisted births (UABs) occur to Black women than white women [3], but there are no published qualitative studies of out of hospital birth (OOHB) or UAB that include Black women’s voices. The present study aims to investigate the OOHB decision-making of two clinically important and understudied subgroups of women: Black women and women who have experienced childhood trauma. Studies indicate that planned out-of-hospital birth (OOHB) is safe and satisfying for women; there is great variation among ethnic groups, and Black women are underrepresented. The purpose of this study is to fill a gap in understanding reasons for choosing OOHB or UAB for two clinically important sub-groups of women: Black women, and women who have experienced childhood physical or sexual abuse
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
