Against the grain: midwives' experiences of facilitating home birth outside of guidelines

Abstract

Background Midwifery standards promote autonomous decision-making and informed choice, resulting in maternal home birth choices which may contravene guidelines. There is a paucity of evidence exploring midwives' experiences of managing these choices. Aims To explore the lived experiences of midwives facilitating home birth outside of guidelines. Methods A qualitative design using an interpretive hermeneutic cycle to analyse semi-structured interviews. Findings Participants reported confidence in supporting maternal choices, identifying barriers including other birth supporters. Perceived levels of risk, previous experience and safety concerns impacted on confidence. Peer, unit and professional midwifery advocate (PMA) support were identified as being beneficial to midwives. Recommendations Expansion of birth choices clinics; implementation of dedicated home birth teams; guideline review for midwife led birthing units; expansion of the PMA role; implementation of a structured debriefing service and further research looking at women's choices, and the impact of the loss of midwifery supervision.