Birthing outside the system: perceptions of risk amongst Australian women who have freebirths and high risk homebirths.
BACKGROUND
homebirth for low risk women attended by competent midwives who are networked within a responsive maternity care service is supported by research as safe. Concerns exist over the safety of homebirths which are unattended by trained health professionals, or for women with medically defined risk factors. Both these birth choices are unsupported by mainstream maternity care options in Australia and therefore represent birth choices considered to be 'outside the system'.


OBJECTIVE
to explore the perceptions of risk held by women who choose to have a freebirth (birth at home intentionally unattended by a trained birth attendant) or a 'high-risk' homebirth (professionally attended home birth where a mother or baby has medically defined risk factors). Both of these choices are considered to be 'outside the system'.


METHODS
twenty women were interviewed about their choice to 'birth outside the system', nine choosing freebirth and 11 choosing to have an attended homebirth despite the presence of medically defined risk factors; three were primiparous and seventeen were multiparous. Women intending to have, or having had a freebirth or high risk homebirth, were interviewed using semi-structured interviews. Interviews were transcribed and analysed using thematic analysis.


RESULTS
the three main themes about perceptions of risk that were evident in this study were: 'Birth always has an element of risk', 'The hospital is not the safest place to have a baby'; and 'interference is a risk'.


CONCLUSIONS
the participants acknowledge that birth is a time in life that carries an element of risk. They perceive that hospital represents a more risky place to give birth than at home and that interventions and interruptions during labour and birth increase risk. Women who birth outside the system perceive the risks of birth in hospital differently to most women. These women feel that by birthing outside the system they are making a choice that protects them and their babies from the risks associated with birthing in hospital and thus provides them with the best and safest birthing option.


CONCLUSIONS
in pursuing the best for themselves and their babies, women who birth outside the system spent a lot of time and energy considering the risks and weighing these up. For them birth in hospital is considered less safe than birth at home.
School of Nursing and Midwifery, College of Health and Science, University of Western Sydney, Parramatta Campus, Locked Bag 1797, Penrith South DC, NSW 2751, Australia. 13464758@student.uws.edu.au
Melanie
M
Jackson
Hannah
H
Dahlen
Virginia
V
Schmied
D000328:Adult; D001315:Australia; D002755:Choice Behavior; D003657:Decision Making; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D006700:Home Childbirth / Q000523:psychology*; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000379:methods; D009035:Mothers / Q000523:psychology*; D009723:Nurse-Patient Relations; D036801:Parturition / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D012944:Social Support; D055815:Young Adult