Utah obstetricians’ opinions of planned home birth and conflicting NICE/ACOG guidelines: A qualitative study

Abstract

Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth.

Exploring social and health care representations about home birth: An Integrative Literature Review

“…Some professionals advise against giving birth at home, while also supporting women's right to choose. Clearly, there is some confusion about the benefits of home birth as many professionals report not being familiar with the scientific literature on planned home birth (Rainey, Simonsen, Stanfors, Shoaf, & Baayd, 2017).…”

“…Despite the WHO’s international recommendations (WHO, 2015) as well as a number of studies that validate birth care at home (ACNM, 2015; De Jonge et al, 2009; Hutton et al, 2019; Olsen & Clausen, 2012; Rigg et al, 2017; Scarf et al, 2018) health professionals do not suggest it is a valid and safe option (Rainey et al, 2017).…”

How to Make the Hospital an Option Again: Midwives’ and Obstetricians’ Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines

“…This would allow women to receive care from one known care provider throughout their pregnancy and birth, and enable women to have an (indicated) hospital birth—under the supervision of an obstetrician—with their own community midwife by their side. The approach used at the designated clinic in Nijmegen could also be helpful for maternity care providers in other contexts: it could make them feel more prepared and less vulnerable when a woman declines recommended care [ 3 , 8 , 26 ]. The psychological impact on care providers when poor outcomes occur must be taken into account, and healthcare institutions should formulate a plan on how to act when this affects medical teams and provide adequate support and (legal) protection for their employees.…”

“…An increasing number of maternity care providers—particularly in high-income countries—encounter highly-educated and well-informed pregnant women who request less care than recommended by medical professionals [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. These women desire maternity care that is more in line with their personal ideas and preferences instead of merely sticking to what medical guidelines recommend [ 1 , 2 , 4 , 5 , 7 , 10 , 11 ].…”

“…The working relationship between a woman and a care provider can be threatened when a woman requests less care than recommended. These requests can cause care providers to feel uncomfortable, vulnerable, fearful and frustrated [ 3 , 4 , 8 , 13 ]. Internationally, steps have been taken to support maternity care providers in caring for women who request less care than recommended.…”