"It's my Home away from Home:" A hermeneutic phenomenological study exploring decision-making experiences of choosing a freestanding birth centre for perinatal care.

ABSTRACT

PROBLEM: The high-value, midwifery-led birth centre (BC) model of care is underutilized in the United States, a country with high rates of obstetric intervention and maternal morbidity and mortality. BACKGROUND: Birth setting decision-making is a complex, preference-sensitive, and resource-dependent process. Understanding how people choose BCs for care may help increase the utilization of BCs and generate positive perinatal outcomes. AIM: This study explores the decision-making experiences of people with Medicaid insurance who chose to give birth in a BC in Massachusetts by gathering interview data to interpret and provide meaning about their selection of birth setting. METHODS: We employed a hermeneutic phenomenology study to interview people about their decision to give birth in a BC. Interview data were coded using a hybrid deductive-inductive approach and analyzed using reflexive thematic analysis to interpret and provide meaning. FINDINGS: Twelve women participated in the study. Five themes emerged that described participants' decision-making processes 1) Stepping Away from "the System," 2) Decision-Making with External Influences, 3) Accessing BC Care, 4) Finding a Home at the BC, and 5) Decision-Making as a Temporal Process. DISCUSSION: The decision to choose a BC was a dynamic process that occurred over time and was influenced by factors such as the quality of care, accessibility, external influences, and the physical environment. CONCLUSION: Prioritizing an individual's capacity to choose their birth setting and fostering awareness about options in the context of informed decision-making are pivotal steps toward attaining equity in perinatal health. Securing public insurance coverage and equitable reimbursement for BCs represent essential policies aimed at facilitating universal access to the BC model for all people.