title: Birth environment facilitation by midwives assisting in non-hospital births: a qualitative interview study.
abstract: OBJECTIVE
  midwifery homes (similar to birth centres) are rich in midwifery wisdom and skills that differ from those in hospital obstetrical departments, and a certain percentage of pregnant women prefer birth in these settings. This study aimed to understand the organisation of the perinatal environment considered important by independent midwives in non-hospital settings and to clarify the processes involved.
  
  
  METHODS
  semi-structured qualitative interview study and constant comparative analysis.
  
  
  METHODS
  14 independent midwives assisting at births in midwifery homes in Japan, and six independent midwives assisting at home births.
  
  
  METHODS
  Osaka, Kyoto, Nara, and Shiga, Japan.
  
  
  RESULTS
  midwives assisting at non-hospital births organised the birth environment based on the following four categories: 'an environment where the mother and family are autonomous'; 'a physical environment that facilitates birth'; 'an environment that facilitates the movement of the mother for birth'; and 'scrupulous safety preparation'. These, along with their sub-categories, are presented in this paper.
  
  
  CONCLUSIONS
  independent midwives considered it important to create a candid relationship between the midwife and the woman/family from the period of pregnancy to facilitate birth in which the woman and her family were autonomous. They also organised a distinctive environment for non-hospital birth, with preparations to guarantee safety. Experiential knowledge and skills played a major part in creating an environment to facilitate birth, and the effectiveness of this needs to be investigated objectively in future research.
authors.affiliation: Department of Maternity Nursing, Faculty of Nursing, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan. Electronic address: igarashi@naramed-u.ac.jp.
authors.forename: Toshiko
authors.initials: T
authors.lastname: Igarashi
authors.affiliation: Department of Maternity Nursing, Faculty of Nursing, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Wakita
authors.affiliation: Department of Public Health, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Kikuko
authors.initials: K
authors.lastname: Miyazaki
authors.affiliation: Department of Public Health, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
mesh_terms: D000328:Adult; D000368:Aged; D016550:Birthing Centers; D004777:Environment; D005260:Female; D006700:Home Childbirth / Q000379:methods*; D006801:Humans; D007564:Japan; D008875:Middle Aged; D008880:Midwifery / Q000379:methods*; D036301:Qualitative Research
keywords: Environment; Midwifery; Natural childbirth; Qualitative research