Getting kicked off the program: Women's experiences of antenatal exclusion from publicly-funded homebirth in Australia.
Childbirth
Continuity of Care
Home Birth
Midwifery
Pregnancy Complications
Journal
Women and birth : journal of the Australian College of Midwives
ISSN: 1878-1799
Titre abrégé: Women Birth
Pays: Netherlands
ID NLM: 101266131
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
16
12
2021
revised:
09
06
2022
accepted:
20
06
2022
pubmed:
29
6
2022
medline:
25
1
2023
entrez:
28
6
2022
Statut:
ppublish
Résumé
Eligibility criteria for publicly-funded homebirth models are strict and, as such, many women who initially plan a homebirth later become excluded. 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. To explore the experiences of women who planned a publicly-funded homebirth and were later excluded due to pregnancy complications or risk factors. A qualitative descriptive approach was taken. Recruitment was via social media sites specifically related to homebirth in Australia. Data collection involved semi-structured telephone interviews. Transcripts were thematically analysed. Thirteen women participated. They were anxious about 'Jumping through hoops' to maintain their low-risk status. After being 'Kicked off the program', women carefully 'negotiated the system' in order to get the birth they wanted in hospital. Some women felt bullied and coerced into complying with hospital protocols that did not account for their individual needs. Maintaining the midwife-woman relationship was a protective factor, decreasing negative experiences. 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-woman 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.
Sections du résumé
PROBLEM
OBJECTIVE
Eligibility criteria for publicly-funded homebirth models are strict and, as such, many women who initially plan a homebirth later become excluded.
BACKGROUND
BACKGROUND
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.
AIM
OBJECTIVE
To explore the experiences of women who planned a publicly-funded homebirth and were later excluded due to pregnancy complications or risk factors.
METHODS
METHODS
A qualitative descriptive approach was taken. Recruitment was via social media sites specifically related to homebirth in Australia. Data collection involved semi-structured telephone interviews. Transcripts were thematically analysed.
FINDINGS
RESULTS
Thirteen women participated. They were anxious about 'Jumping through hoops' to maintain their low-risk status. After being 'Kicked off the program', women carefully 'negotiated the system' in order to get the birth they wanted in hospital. Some women felt bullied and coerced into complying with hospital protocols that did not account for their individual needs. Maintaining the midwife-woman relationship was a protective factor, decreasing negative experiences.
DISCUSSION
CONCLUSIONS
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-woman relationship and assess risk on an individual basis.
CONCLUSION
CONCLUSIONS
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.
Identifiants
pubmed: 35764492
pii: S1871-5192(22)00109-3
doi: 10.1016/j.wombi.2022.06.008
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e179-e185Informations de copyright
Copyright © 2023 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest None declared.