title: 'Just waiting to be hauled over the coals': home birth midwifery in Ireland.
abstract: OBJECTIVE
  to describe the context of Irish home birth midwives' practise experience.
  
  
  METHODS
  ethnography derived from participant observation, unstructured interview and documentary analysis.
  
  
  METHODS
  women and midwives' homes and meeting places in Ireland.
  
  
  METHODS
  21 self-employed community midwives.
  
  
  RESULTS
  choice of place of birth is extremely limited in Ireland. Structural and professional supports for home birth and midwifery are lacking. Home birth midwives highly value midwifery professionalism but are professionally isolated. They promote women's birthing autonomy and choice of place of birth. However, they experience and anticipate negative, even punitive, responses from their own and other professions. This ethnography describes a particularly volatile period in Irish home birth midwifery practice.
  
  
  CONCLUSIONS
  Irish home birth midwives are professionally isolated which, given wider cultural antagonism to home birth, perfuses their practice with an element of defensiveness. Strong midwifery association is a key pillar of professionalism globally. In Ireland, the lack of a strong professional body undermines autonomous midwifery practice in all settings but particularly in the home. The midwifery philosophy of 'being with woman' appears to run contrary to professionalising discourses where the professional 'knows best'. Contemporary cultural expectations of professionalism such as clinical indemnification and risk averse practice protocols, bring challenges to autonomous midwifery practice.
  
  
  CONCLUSIONS
  place and context of birth effects not only the woman's birth experience but the midwife's professional autonomy. Without supports for autonomous midwifery, autonomous birthing is under threat. Place of birth effects birth experience and birth quality, not least because it is that context which also influences, for good or ill, midwifery autonomy.
authors: School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland. coboyle@tcd.ie
authors: Colm
authors: C
authors: OBoyle
mesh_terms: D002983:Clinical Competence; D005260:Female; D006700:Home Childbirth; D006801:Humans; D007494:Ireland; D008427:Maternal Health Services / Q000379:methods*; D008880:Midwifery / Q000458:organization & administration*; D011247:Pregnancy; D017009:Professional Autonomy; D011364:Professional Practice / Q000458:organization & administration*
keywords: Ethnography; Home birth; Midwifery; Professionalism