Why do women choose homebirth in Australia? A national survey

Abstract

Background: In Australia there have been regulatory and insurance changes negatively affecting homebirth.

Aim: The aim of this study is to explore the characteristics, needs and experiences of women choosing to have a homebirth in Australia.

Methods: A national survey was conducted and promoted through social media networks to women who have planned a homebirth in Australia. Data were analysed to generate descriptive statistics.

Findings: 1681 surveys were analysed. The majority of women indicated a preference to give birth at home with a registered midwife. However, if a midwife was not available, half of the respondents indicated they would give birth without a registered midwife (freebirth) or find an unregistered birthworker. A further 30% said they would plan a hospital or birth centre birth. In choosing homebirth, women disclosed that they wanted to avoid specific medical interventions and the medicalised hospital environment. Nearly 60% of women reported at least one risk factor that would have excluded them from a publicly funded homebirth programme. Many women described their previous hospital experience as traumatic (32%) and in some cases, leading to a diagnosis of post-traumatic stress disorder (PTSD, 6%). Only 5% of women who reported on their homebirth experience considered it to be traumatic (PTSD, 1%). The majority of these were associated with how they were treated when transferred to hospital in labour.

Conclusion: There is an urgent need to expand homebirth options in Australia and humanise mainstream maternity care. A potential rise in freebirth may be the consequences of inaction.

Keywords: Access; Birth trauma; Choice; Coercion; Freebirth; Health regulation; Homebirth; Human rights; Intervention; Midwife; Unregulated birthworker (UBW).