title: Utah obstetricians' opinions of planned home birth and conflicting NICE/ACOG guidelines: A qualitative study.
abstract: The United Kingdom's National Institute for Health and Care Excellence (NICE) recently published recommendations that support planned home birth for low-risk women. The American College of Obstetricians and Gynecologists (ACOG) remains wary of planned home birth, asserting that hospitals and birthing centers are the safest birth settings. Our objective was to examine opinions of obstetricians in Salt Lake City, Utah about home birth in the context of rising home birth rates and conflicting guidelines.
  
  
  
  Participants were recruited through online searches of Salt Lake City obstetricians and through snowball sampling. We conducted individual interviews exploring experiences with and attitudes toward planned home birth and the ACOG/NICE guidelines.
  
  
  
  Fifteen obstetricians who varied according to years of experience, location of medical training, sex, and subspecialty (resident, OB/GYN, maternal-fetal medicine specialist) were interviewed. Participants did not recommend home birth but supported a woman's right to choose her birth setting. Obstetrician opinions about planned home birth were shaped by misconceptions of home birth benefits, confusion surrounding the scope of care at home and among home birth providers, and negative transfer experiences. Participants were unfamiliar with the literature on planned home birth and/or viewed the evidence as unreliable. Support for ACOG guidelines was high, particularly in the context of the United States health care setting.
  
  
  
  Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth.
authors.affiliation: Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Emily
authors.identifier: 0000-0003-4861-2543
authors.initials: E
authors.lastname: Rainey
authors.affiliation: University of Utah College of Nursing, Salt Lake City, UT, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Simonsen
authors.affiliation: Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT, USA.|Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Stanford
authors.affiliation: Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Shoaf
authors.affiliation: Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Jami
authors.initials: J
authors.lastname: Baayd
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006700:Home Childbirth / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008880:Midwifery / Q000592:standards*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D036301:Qualitative Research; D012955:Societies, Medical; D013222:State Medicine; D006113:United Kingdom; D014589:Utah
keywords: NICE and ACOG guidelines; obstetrician opinions; planned home birth