Why women chose unassisted home birth in Malaysia: a qualitative study

Nur Amani Natasha Ahmad Tajuddin,Ilham Ameera Ismail,Siti Nurkamilla Ramdzan,Julia Suhaimi,Sajaratulnisah Othman,Ahmad Ihsan Abu Bakar,Nurainul Hana Shamsuddin,Khasnur Abd Malek

doi:10.1186/s12884-020-02987-9

Nur Amani Natasha Ahmad Tajuddin, Ilham Ameera Ismail + Show 6 more

Open Access

https://doi.org/10.1186/s12884-020-02987-9

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Abstract

BackgroundIncidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities. We aimed to explore the reasons for women to make such decisions.MethodsTwelve women participated in in-depth interviews. They were recruited using a snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literature. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.ResultsWomen in this study described a range of birthing experiences and personal beliefs as to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) birth is a natural process, iii) expressing autonomy and iv) faith. Such decision to birth at home unassisted was firm and steadfast despite the possible risks and complications that can occur. Giving birth is perceived to occur naturally regardless of assistance, and unassisted home birth provides the preferred environment which health facilities in Malaysia may lack. They believed that they were in control of the birth processes apart from fulfilling the spiritual beliefs.ConclusionsWomen may choose unassisted home birth to express their personal views and values, at the expense of the health risks. Apart from increasing mothers’ awareness of the possible complications arising from unassisted home births, urgent efforts are needed to provide better birth experiences in healthcare facilities that resonate with the mothers’ beliefs and values.

Highlights

Incidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities
The presence of skilled health personnel during births is crucial to achieving this aim, and the proportion of births attended by skilled health personnel is one of the critical indicators used to monitor the achievement of the goal [1]
World Health Organisation (WHO) has refined the definition of skilled health personnel providing care for childbirth as ‘competent maternal and new-born health professionals educated, trained and regulated to national and international standards’ [2]

Summary

Introduction

Incidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities. The presence of skilled health personnel during births is crucial to achieving this aim, and the proportion of births attended by skilled health personnel is one of the critical indicators used to monitor the achievement of the goal [1]. Most of the births attended by skilled health personnel occur at healthcare facilities. Some women prefer birthing at home, as they believe it is safer and provides a better outcome for the mother and baby as compared to birthing at a hospital [3]. In the Netherlands, women with low obstetric risk are given a choice to either birth at home under the supervision of a community midwife or in the hospital [4].

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