Making sense of childbirth choices; exploring the decision to freebirth in the UK

Abstract

Freebirthing or unassisted birth is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision. This is a radical childbirth choice, which has potential morbidity risks for mother and baby. To date there have been no UK based studies. The aim of this study was to explore the decision making experience of women who chose to freebirth in a UK context. An interpretative phenomenological study was carried out. A purposive sampling method combined with a ‘snowball’ technique was used to recruit women to the study (n=10). Inclusion and exclusion criteria were applied. Data collection comprised of women completing a narrative account. This was followed up with an in-depth interview. Data analysis was carried out using interpretative methods informed by Heidegger and Gadamer’s hermeneutic-phenomenological concepts. Three main themes emerged from the data: ‘contextualising herstory’; ‘diverging paths of decision making’ and ‘the converging path of decision making’. With the exception of one participant, the women were making an active choice based upon their previous birth experiences. For some the decision was borne out of a negative experience which was then compounded by a further poor experience with maternity services. Namely obstructive practices by maternity professionals that limited their choice to book a homebirth. Therefore, in order to feel safe they opted to freebirth. For others this was borne out of a positive experience in which their decision evolved in trying to further improve their birthing experience, therefore a midwife became redundant. The findings mirror that of the metasynthesis carried out by Feeley et al. (2015), but unique to this study is that it is based in a UK setting. This is an important finding as the UK has a strong midwifery culture which is philosophically embedded in woman-centred care. The findings of this study demonstrate that this is not always achieved leading some women to make extreme birthing choices. Further research is essential to determine why there is such a gap between midwifery philosophy and actual care provision