"I knew there has to be a better way": Women's pathways to freebirth in Poland.

BACKGROUND: Each year a small number of women decide to birth at home without midwifery and medical assistance despite the availability of maternity services in the country. This phenomenon is called freebirth and can be used as a lens to look into shortcomings of maternity care services. AIM: By exploring women's pathways to freebirth, this article aims to examine the larger context of maternity services in Poland and identify elements of care contributing to women's decision to birth without midwifery and medical assistance. METHODS: A qualitative methodology was used employing elements of ethnographic fieldwork, including digital ethnography. Semi-structured interviews with twelve women who freebirth, analysis of online support groups, secondary sources of information and elements of participant observation were used. FINDINGS: Women's decisions to freebirth were born out of their previous negative experiences with maternity care. Persistent use of medical technology and lack of respect from maternity care providers played a major role in pushing women away from available Polish maternity services. While searching for a better environment for themselves and their babies for the subsequent births, women experienced a rigidity of both mainstream and homebirth services and patchy availability of the latter that contributed to their decisions to freebirth. CONCLUSIONS: Freebirth appears to be a consequence of inadequate maternity services both mainstream and homebirth rather than a preference. Women's freebirth experiences can be used to improve maternity care in Poland and inform similar contexts globally.

Experiences of Dutch maternity care professionals during the first wave of COVID-19 in a community based maternity care system.

BACKGROUND AND OBJECTIVE: During the COVID-19 pandemic the organization of maternity care changed drastically; this study into the experiences of maternity care professionals with these changes provides suggestions for the organization of care during and after pandemics. DESIGN: An online survey among Dutch midwives, obstetricians and obstetric residents. Multinomial logistic regression analyses were used to investigate associations between the respondents' characteristics and answers. RESULTS: Reported advantages of the changes were fewer prenatal and postpartum consultations (50.1%). The necessity and safety of medical interventions and ultrasounds were considered more critically (75.9%); 14.8% of community midwives stated they referred fewer women to the hospital for decreased fetal movements, whereas 64.2% of the respondents working in hospital-based care experienced fewer consultations for this indication. Respondents felt that women had more confidence in giving birth at home (57.5%). Homebirths seemed to have increased according to 38.5% of the community midwives and 65.3% of the respondents working in hospital-based care. Respondents appreciated the shift to more digital consultations rather than face-to-face consultations. Mentioned disadvantages were that women had appointments alone, (71.1%) and that the community midwife was not allowed to join a woman to obstetric-led care during labour and subsequently stay with her (56.8%). Fewer postpartum visits by family and friends led to more tranquility (59.8%). Overall, however, 48.0% of the respondents felt that the safety of maternity care was compromised due to policy changes. CONCLUSIONS: Maternity care professionals were positive about the decrease in routine care and the increased confidence of women in home birth, but also felt that safety in maternity care was sometimes compromised. According to the respondents in a future crisis situation it should be possible for community midwives to continue to deliver a personal handover after the referral of women to the hospital, and to stay with them.

Out-of-Hospital Birth.

Since the 1970s, most births in the United States have been planned to occur in a hospital. However, a small percentage of Americans choose to give birth outside of a hospital. The number of out-of-hospital births has increased, with one in every 61 U.S. births (1.64%) occurring out of the hospital in 2018. Out-of-hospital (or community) birth can be planned or unplanned. Of those that are planned, most occur at home and are assisted by midwives. Patients who choose a planned community birth do so for multiple reasons. International observational studies that demonstrate comparable outcomes between planned out-of-hospital and planned hospital birth may not be generalizable to the United States. Most U.S. studies have found statistically significant increases in perinatal mortality and neonatal morbidity for home birth compared with hospital birth. Conversely, planned community birth is associated with decreased odds of obstetric interventions, including cesarean delivery. Perinatal outcomes for community birth may be improved with appropriate selection of low-risk, vertex, singleton, term pregnancies in patients who have not had a previous cesarean delivery. A qualified, licensed maternal and newborn health professional who is integrated into a maternity health care system should attend all planned community births. Family physicians are uniquely poised to provide counseling to patients and their families about the risks and benefits associated with community birth, and they may be the first physicians to evaluate and treat newborns delivered outside of a hospital.

[Home births: A growing phenomenon with potential risks]. / Parto domiciliario: un fenómeno creciente con potenciales riesgos.

Home birth is a controversial issue that raises safety concerns for paediatricians and obstetricians. Hospital birth was the cornerstone to reduce maternal and neonatal mortality. This reduction in mortality has resulted in considering pregnancy and childbirth as a safe procedure, which, together with a greater social awareness of the need for the humanisation of these processes, have led to an increase in the demand for home birth. Studies from countries such as Australia, the Netherlands, and United Kingdom show that home birth can provide advantages to the mother and the newborn. It needs to be provided with sufficient material means, and should be attended by trained and accredited professionals, and needs to be perfectly coordinated with the hospital obstetrics and neonatology units, in order to guarantee its safety. Therefore, in our environment, there are no safety data or sufficient scientific evidence to support home births at present.

Seeing birth in a new light: The transformational effect of exposure to homebirth for hospital-based midwives.

OBJECTIVE: The aim of the study was to explore hospital-based midwives' experiences of providing publicly-funded homebirth services in Australia. DESIGN: A qualitative descriptive study using a constructivist grounded theory methodology was undertaken. SETTING: Five different states or territories of Australia where publicly-funded homebirth services were operating. PARTICIPANTS: Interviews were conducted with 21 midwives and midwifery managers from eight different public hospitals who had recent experience of working in, or with, publicly-funded homebirth models. FINDINGS: Witnessing undisturbed birth in the home setting transformed midwives' attitudes towards birth. Following exposure to homebirth, many midwives felt they were seeing undisturbed birth for the first time. This led them to question their current understanding of physiological birth and develop a new awareness of the powerful influence that the environment has on labouring women. This new understanding resulted in changes to their practice. KEY CONCLUSIONS: For midwives accustomed to working in hospital settings, exposure to homebirth deepened their understanding of physiological birth, resulting in a perspective transformation and subsequent shift in practice. IMPLICATIONS FOR PRACTICE: Exposure to homebirth may motivate midwives to alter their practice in both home and hospital settings in order to shift the power dynamic between women and caregivers and protect women from unnecessary disturbance during labour.

Home Birth in the Era of COVID-19: Counseling and Preparation for Pregnant Persons Living with HIV.

With the coronavirus disease 2019 (COVID-19) pandemic in the United States, a majority of states have instituted "shelter-in-place" policies effectively quarantining individuals-including pregnant persons-in their homes. Given the concern for COVID-19 acquisition in health care settings, pregnant persons with high-risk pregnancies-such as persons living with HIV (PLHIV)-are increasingly investigating the option of a home birth. Although we strongly recommend hospital birth for PLHIV, we discuss our experience and recommendations for counseling and preparation of pregnant PLHIV who may be considering home birth or at risk for unintentional home birth due to the pandemic. We also discuss issues associated with implementing a risk mitigation strategy involving high-risk births occurring at home during a pandemic. KEY POINTS: · Coronavirus disease 2019 pandemic has increased interest in home birth.. · Women living with HIV are pursuing home birth.. · Safe planning is paramount for women living with HIV desiring home birth, despite recommending against the practice..

Birthing outside the system: the motivation behind the choice to freebirth or have a homebirth with risk factors in Australia.

BACKGROUND: Childbirth in Australia occurs predominantly in a biomedical context, with 97% of births occurring in hospital. A small percentage of women choose to birth outside the system - that is, to have a midwife attended homebirth with risk factors, or a freebirth, where the birth at home is intentionally unattended by any health professional. METHOD: This study used a Grounded Theory methodology. Data from 13 women choosing homebirth and 15 choosing freebirth were collected between 2010 and 2014 and analysed over this time. RESULTS: The core category was 'wanting the best and safest,' which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was 'finding a better way'. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies. CONCLUSION: Shortfalls in the Australian maternity care system is the major contributing factor to women's choice to give birth outside the system. Systematic improvements should prioritise humanising maternity care and the expansion of birth options which prioritise midwifery-led care for women of all risk.

Providing Care for Infants Born at Home.

The American Academy of Pediatrics (AAP) believes that current data show that hospitals and accredited birth centers are the safest settings for birth in the United States. The AAP does not recommend planned home birth, which has been reported to be associated with a twofold to threefold increase in infant mortality in the United States. The AAP recognizes that women may choose to plan a home birth. This statement is intended to help pediatricians provide constructive, informed counsel to women considering home birth while retaining their role as child advocates and to summarize appropriate care for newborn infants born at home that is consistent with care provided for infants born in a medical care facility. Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care consistent with that highlighted in this statement, which is more completely described in other publications from the AAP, including Guidelines for Perinatal Care and the Textbook of Neonatal Resuscitation All health care clinicians and institutions should promote communications and understanding on the basis of professional interaction and mutual respect.

Integrative power in Swiss home-like childbirths: A qualitative multiple case study.

OBJECTIVE: To increase understanding of integrative power in decision-making in home-like childbirth from midwives' and women's perspectives. DESIGN: A qualitative multiple case study. SETTING: Two regions of Switzerland, a French and a German-speaking. PARTICIPANTS: Twenty interviews with midwives and 20 with women and some partners who had experienced complications in home-like births. METHODS: Data were collected from in-depth interviews relevant for casestudy. Four cases during second stage of labour were carefully selected using literal replication logic. Interview transcripts were analysed in developing case descriptions and in interpreting mechanisms related to perception of power in making decision. FINDINGS: The analysis of each case and a cross-case comparison showed that mechanisms for building integrative power, such as creation of relationships, cooperation, loyalty, legitimacy and respect, were highly visible in midwifery decision-making activities. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The study highlighted the visibility of integrative power mechanisms in decision-making in homelike settings. Until now, mechanisms of positive power in midwifery have been poorly described in literature. Integrative power could be a promising strategy to reinforce decision-making strategies. Therefore, clinical and policy measures explicitly addressing the positive aspects of power should be developed and evaluated.

Adapting the 2015 Mother-Baby Friendly Birth Facility Guidelines for Semi-nomadic Pastoralist Communities in Laikipia and Samburu Counties of Kenya.

Purpose To adapt the 2015 International Federation of Gynecologists and Obstetricians (FIGO), International Confederation of Midwives (ICM), White Ribbon Alliance (WRA), International Pediatric Association (IPA), and WHO auspiced Guidelines on Mother-Baby Friendly Facilities to a particular sub-population; seminomadic pastoralist communities of Laikipia and Samburu Counties, Kenya. We anticipate an increased utilization of childbirth services by improving their acceptability. Description We drafted a Pastoralist Friendly Birthing Facility Checklist based on the FIGO/ICM/WRA/IPA/WHO guidelines and previous research in this context. We employed mixed methods to finalise the adaptation: a workshop with 27 local stakeholders; interviews with ten health planners and skilled birth attendants (SBAs); and ten focus group discussions (FGDs) with health committee members, community health workers, mothers and traditional birth attendants (TBAs). A facility audit of dispensaries across five group ranches was also undertaken. Assessment The final Checklist was divided into: characteristics of care and the environment; care during labour and birth; post-partum care; and community staff relationships. It was endorsed by the Ministries of Health in the relevant counties, and by women, SBAs and TBAs. No facility currently satisfies all the criteria specified in the Checklist. Conclusion The FIGO/ICM/WRA/IPA/WHO Guidelines were successfully adapted and can be used to ensure health facilities meet the needs of pastoralist women.

Factors associated with home births in a selected ward in Mberengwa District, Zimbabwe.

OBJECTIVE: Despite many efforts put by the Government to ensure that women give birth in health facilities under trained personnel supervision; statistics suggest that ward 2 in Mberengwa District in Zimbabwe has the highest home births. This study sought to assess factors that are associated with home births in ward 2 of Mberengwa District in Zimbabwe. DESIGN: Case- control. SETTING: Ward 2 in Mberengwa District in Zimbabwe. PARTICIPANTS: 35 and 105 women who gave birth at home and facilities, respectively. METHODS: A piloted researcher administered questionnaire was used to collect data from systematically selected respondents on factors leading to their choice of place to give birth. The home and facility births were geocoded using a Garmin etrex-30 Global Positioning System receiver and exported to Quantum Geographic Information System software for spatial analysis and mapping. RESULTS: Factors associated with home births were; being uneducated (2.90, CI 1.08-7.57), unemployed (2.56, CI 1.08-6.23), could not afford facility bills (20.92, 3.19-160.31), and lack of access to Ante Natal Care (23.8, 7.04-90). 69% (24) of cases and 30% (32) of resided within the 5 km radius of health facilities. There was significant difference in levels of knowledge between cases and controls about benefits of giving birth in facilities. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It is acknowledged that costs are a huge barrier in accessing antenatal care services. These factors together with others need to be addressed so as to improve access by pregnant women to health facilities.

Enacting Homebirth Bodies: Midwifery Techniques in Germany.

Building on insights from science and technology studies-inspired anthropological research on reproduction, this paper uses a praxiographic approach to analyze homebirth midwifery practices in Germany. I show that such practices are syncretic, and that techniques of routinizing and multiplying obstetrical interventions are combined in more or less coherent ways to configure pregnancies and births as physical, emotional, and social becomings. In the process of attending, homebirth bodies learn to co-respond to each other, to the midwifery techniques, and to the homebirth environment. Understanding how and with which aims midwives and women invest in those longterm engagements specific to homebirth surroundings may inform clinical practices.

"We need good nutrition but we have no money to buy food": sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan.

BACKGROUND: Determinants of newborn health and survival exist across the reproductive life cycle, with many sociocultural and contextual factors influencing outcomes beyond the availability of, and access to, quality health services. In order to better understand key needs and opportunities to improve newborn health in refugee camp settings, we conducted a multi-methods qualitative study of the status of maternal and newborn health in refugee camps in Upper Nile state, South Sudan. METHODS: In 2016, we conducted 18 key informant interviews with health service managers and front-line providers and 13 focus group discussions in two Sudanese refugee camps in Maban County, South Sudan. Our focus group discussions comprised 147 refugee participants including groups of mothers, fathers, grandmothers, traditional birth attendants, community health workers, and midwives. We analysed our data for content and themes using inductive and deductive techniques. RESULTS: We found both positive practices and barriers to newborn health in the camps throughout the reproductive lifecycle. Environmental and contextual factors such as poor nutrition, lack of livelihood opportunities, and insecurity presented barriers to both general health and self-care during pregnancy. We found that the receipt of material incentives is one of the leading drivers of utilization of antenatal care and facility-based childbirth services. Barriers to facility-based childbirth included poor transportation specifically during the night; insecurity; being accustomed to home delivery; and fears of an unfamiliar birth environment, caesarean section, and encountering male health care providers during childbirth. Use of potentially harmful traditional practices with the newborn are commonplace including mixed feeding, use of herbal infusions to treat newborn illnesses, and the application of ash and oil to the newborn's umbilicus. CONCLUSIONS: Numerous sociocultural and contextual factors impact newborn health in this setting. Improving nutritional support during pregnancy, strengthening community-based transportation for women in labour, allowing a birth companion to be present during delivery, addressing harmful home-based newborn care practices such as mixed feeding and application of foreign substances to the umbilicus, and optimizing the networks of community health workers and traditional birth attendants are potential ways to improve newborn health outcomes.

Birthplace in Australia: Antenatal preparation for the possibility of transfer from planned home birth.

OBJECTIVE: The aim of the study was to explore how women and midwives prepare, during the antenatal period, for the possibility of intrapartum transfer from planned home birth. DESIGN: A Constructivist Grounded Theory approach was taken in order to focus upon the social interactions and processes that emerged. SETTING: Urban and regional areas in four states of south eastern Australia. PARTICIPANTS: Thirty-one semi-structured interviews were conducted with women and midwives. FINDINGS: There were three sub-categories relating to preparation for the possibility of transfer. These were 'Building the midwife-woman partnership', 'Fostering professional connections' and 'Reducing uncertainty'. The reciprocal trust inherent in the midwife-woman partnership helped women feel safe in relation to the possibility of intrapartum transfer to hospital. Midwives who had positive transfer experiences spoke about their commitment to fostering professional connections with hospitals and health professionals as a part of building the capacity for collaboration if, and when, a transfer occurred. Reducing uncertainty involved preparation that included not only providing information and emotional support to the woman around the possibility of transfer, but also arranging for her to book in to a back-up hospital.

Does Home Birth Reduce the Risk of Pelvic Organ Prolapse?

OBJECTIVES: To determine the relationship between vaginal birth and the development of POP among women who deliv-ered in non-hospital settings (home birth). MATERIAL AND METHODS: Data were collected retrospectively from the files of patients who presented to a hospital outpatient clinic between April 1, 2011 and April 1, 2012 with complaints of urinary incontinence, uterine sagging, vaginal mass, or vaginal pain. The patients' age, height, weight, body mass index, menopause age, number of deliveries, and presence of hypertension and diabetes mellitus were noted. Patients whose urogynecologic evaluation included POP Quantification (POP-Q) scoring were included in the study. The patients were separated into a group of women who had never given birth and another group of women with one or more deliveries. RESULTS: Of the 179 patients in the study, 28 had never given birth and 151 had given birth at least once. The nulliparous patients had no cystocele, rectocele, or uterine prolapse. The prevalence rates of cystocele, rectocele, and uterine prolapse were significantly higher in the multiparous group. Cystocele, rectocele, and uterine prolapse development were significantly correlated with number of deliveries, but there was no statistical association with age, body mass index, menopausal age, diabetes mellitus, or hypertension. univariate analysis reveals that the only factor effective in the development of cytocele, rectocele and prolapse is the number of births. CONCLUSIONS: Our study suggests that only number of deliveries is associated with development of cystocele, rectocele, and uterine prolapse in women who gave birth by vaginal route in residential settings.

Being born at home is natural: care rituals for home birth.

OBJECTIVE: To be aware of the care rituals developed by families when preparing for home birth during the gestational process. METHOD: Qualitative and ethnographic research developed with families during the gestational process. We adopted the observation-participation-reflection model, and the analysis was performed according to ethnonursing. RESULTS: Care rituals are related to the choice of home as a place for childbirth, being characterized as a family's rite of separation to experience this process. Other care rituals involved the preparation of the family and the eldest child as well as the home, the body, and the mind of the pregnant woman, and the choice of destination of the placenta. FINAL CONSIDERATIONS: We must understand the birth process beyond the biological perspective, considering women and their family as a whole, within a cultural context with their beliefs and values.