Homebirth in WA: Why women make this choice.

Background: Homebirths in Western Australia (WA) account for approximately 0.8% of all births. Two consecutive reports from the Perinatal and Infant Mortality Monitoring Committee found increased rates of perinatal mortality in homebirths and recommended a prospective cohort study to assess mortality and morbidity outcomes for women with planned home births in WA. The Homebirth in WA Study, of which this thesis is a component, has been funded by a directed research grant. Aim: The aim of this study was to explore the specific reasons why women in WA choose homebirth. Research on homebirths is focused on perinatal outcomes and comparisons of satisfaction between hospital and homebirth. Based on these comparisons, assumptions are made as to why women choose to have a homebirth or make this choice. There is a paucity of research directly addressing the reasons why women make this choice. Methods: This is a quantitative prospective observational study. Pregnant women planning a homebirth in WA were invited to participate in the study. Women recruited into this study (n=135) were asked about their obstetric history and associated satisfaction with their previous birth experience, and were asked to select from any of 27 options as being their reasons for choosing homebirth, with the option to provide additional reasons of their own. They were also asked to select the three most important reasons. Women were asked to rank their perception of how important it is for them to have a homebirth, their perception of the safety, their level of confidence and the support they have received from their spouse and family and friends for their choice. The women were also invited to share further comments. Results: The majority of women (n=107) received care from the Community Midwifery Program and the remainder (n=28) from privately practicing Midwives. In this study 50 women were nulliparous and 85 multiparous. Women who previously had a homebirth reported a higher level of satisfaction (4.7/5) for the birth experience, compared to women who had hospital births (2.3/5). Avoiding unnecessary intervention was the dominant reason for choosing home birth in 95.5% of participants, regardless of parity, education or previous birth experience; this was followed by the comfort and familiarity of the home (93%) and the freedom to make their own choices (86%). Avoiding unnecessary intervention ranked the highest of the 3 most important reasons. Women reported a high level of support for their choice from their spouse (4.65/5) and substantially less from family and friends (3.68/5). They ranked the safety of homebirth highly and had a high level of confidence. The women who elected to share further comments referred most frequently (28%) to GP’s and obstetricians not presenting homebirth as an option, and also made frequent reference to their negative attitude in relation to the women’s choice. Women also commented on the negative attitudes encountered from family and friends, and additional references reflected their attitudes regarding intervention. Conclusion: Women choosing homebirth in WA do so to avoid unnecessary intervention and have the freedom to make their own choices in the surrounds of the home. They receive limited support for their choice from GP’s and obstetricians as well as friends and relatives. This study underscores the reaction of some women to the current rates of obstetric intervention.