Background
Methods
Recruitment and participants
Data collection
Interview guide |
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1. What lead you to choose an UBW to support you with your birth at home?
a. How did you find her?
b. How much did her services cost?
c. How often did you see her?
d. What did she do for you or with you at the birth?
e. Did she provide services post birth?
f. How long for and what did these services entail?
g. How did you reconcile risk vs benefit?
h. What emergency plans did you have in place?
i. How far away from emergency aid were you?
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2. Why did you not choose a home birthing midwife?
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3. How do the services of an UBW and a private midwife differ?
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4. Can you describe your experiences of having being cared for by an unregulated birthworker at home?
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5. What sorts of services would you like to see available to women from mainstream services?
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6. What would you do if the services of an UBW were not available?
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7. What are your views about the proposed legislation to prohibit UBW support women during a homebirth without a midwife?
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8. How might mainstream services improve so you feel you have more options?
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Themes | Subthemes |
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1. A traumatising system | |
2. An inflexible system |
1. Access to midwifery model of care
2. Inflexible models of care
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3 Getting the best of both worlds |
1. Researching options and learning to trust in self
2. Doing it my way
3. Having a safety net
4. Respecting choices
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4 Treated with love and respect versus the mechanical arm on the car assembly line |
1. Respecting choices
2. Negotiated/flexible care feels safe
3. No obligation to conform
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Data analysis
Reflexivity
Results
A traumatising System
I had my first birth in a hospital and ended up a fourth degree tear, immediately after I had a PPH and at the same time on the table holding my baby; I was being asked to sign forms saying I was being stitched and at the same time being told I would never be able to birth vaginally again. I would have to have a caesarean and probably be incontinent for the rest of my life by bowel and bladder…I was absolutely convinced I00% I was going to die… it was so traumatic. (Consumer 2)
I was appalled at the midwives in the hospital and this was a midwifery group practice. I was just appalled…they pushed her; they scared her into having drugs. She wanted to have no drugs. The midwife just kept on saying “well if you don’t hurry up we'll be whipping you down for an emergency caesarean section so you’ve got an hour”. Putting pressure on her and just not supporting her…giving her so much pressure, forcing her to have examinations when she didn’t want them". I just wouldn’t. I was so upset with the whole operation. (Consumer 3)I’ve just been at a homebirth with a homebirth midwife from the hospital and again, I found them extremely rude, they were very pushy; they told the mother off for having the baby before they got there. They wouldn’t respect the fact that she wanted to be left alone to have time with the baby. She was just saying, we need to do this; we need to do that, your baby might die if you don’t have this injection. Reprimanding her for not calling them sooner, it’s just not nice. I just wouldn't do it. (Consumer 3)
An inflexible system
They are so out of their comfort zone and it’s so clinical. You can hide the clinical stuff and make it homely and you can have a double bed so the husband can stay… Birth in water is so ok yet it’s so not achievable in standard hospitals. Labouring and birthing in the shower is almost unheard of here. It’s the simplest things that are so hard to achieve… Birthing in a hospital is so not appealing on so many levels. (Consumer 6)I had a lotus birth; there was no way I could do that in a hospital; they don’t not allow a natural third stage; they don’t allow you to have any natural alternative medicines or anything like that. (Consumer 3)
Access to midwifery models of care
I did make contact with the midwives down at the birthing centre but the home birthing program still had not come through and it wasn’t available… There were no other registered home birthing midwives available. It was at that period where there were no registered midwives…the publicly funded homebirth scheme was not up and running. (Consumer 4)I wanted to be at home but there were no midwives around at that stage. (Consumer 6)They’ve got like the syndicate, lottery system there are so many women that want to go there but there are only so many places. (Consumer 5)
With my first birth, I wasn’t very happy with the services and the people who could assist me. There wasn’t a great deal of choice. (Consumer 7)A big part of it was not being able to afford a homebirth midwife … I wanted a homebirth but I couldn’t afford to have a midwife. (Consumer 2)
I had approached quite a number of midwives previously. A lot of the midwives wouldn’t agree to the potential of a homebirth… I found it quite hard to find someone that was willing to take the risk…A lot of midwives were talking about insurance, they didn’t want to take the risk because they didn’t want to lose their registration. (Consumer 5)
I actually booked in at the birth centre. I tried to enrol in the midwifery group practice but I got knocked back with both of them because at about 12 weeks between my first two children I had a miscarriage. (Consumer 2)I was out of the geographical area, I wasn’t even eligible for it…so I didn’t have access to a birthing centre, only to a hospital…In my State, the line up for the birthing centre, is ridiculous, so many women want to get into the birthing centres in this State, and can’t get in because the waiting list is too long. And so they go to the hospitals, and a lot of them have really shit births. (Consumer 7)
A VBAC mother, she just really felt she didn’t fit into the homebirth scheme because she had a caesarean and she was really determined to have the baby at home. (Provider 5)
Inflexible midwifery models of care
She wanted to do a vaginal examination and I just thought, just leave me. I was actually annoyed with her because I had a point of reference; a different one and she annoyed me. I realised in my heart this is not necessary…It was a really fast birth my second child but she wanted to check, she got a bit nervous at some point and wanted to do a vaginal examination to check how I was progressing. I really didn’t want her to and so ok I just let her do it so she calmed down. I didn’t have that feeling with (UBW), it wasn’t intrusive at all and I really, really valued that. (Consumer 8)
I felt that I would probably be pushed into having more VEs and I didn’t want any VEs or have any monitoring, I didn’t want someone entering into my conscious space. I did speak to midwives and they all basically said from a legal stand point they are required to do all that sort of thing like for their own back up pretty much, which I understand. I didn’t want to put someone in the situation where I was asking them to go against what they had to do when it was something that was making me uncomfortable and when I knew I had another option. (Consumer 2)
Women’s births are being interrupted unnecessarily and the potential that women have to have an empowering birth was being ignored a lot of the time; but other times, usually in the hospital setting, there was no space for it with the rules and what is happening there. (Consumer 4)
You have to have a lot of tests that need to be done and you have to have an ultrasound and things with the registered midwife. I just really like it when I know the birth worker who is with me solely. It’s just me and her. There is not this higher control system that has all these rules that are a blanket rule for everyone… She doesn’t make decisions based on maybe fear of getting in trouble with the medical and legal problems and things like that. (Consumer 5).
Getting the best of both worlds
I chose her because she was extremely experienced, she was very passionate about what I wanted, she was willing to support whatever I wanted to do during the birth, that was stay at home or the be transferred or whatever… and her beliefs were inline with mine. (Consumer 3)I was looking for moral support and someone to out of the intensity of the moment to just recognise we need extra help or no you’re doing fine and that is I guess a professional opinion on how things were going. (Consumer 5)
Researching options and learning to trust in birth
I studied a lot of Leboyer birth and about what happens if you have a drugged birth…and what patterns you set for yourself if you have an induced birth and how that affects your life. (Consumer 3)After doing a lot more reading from a variety of sources and ideologies and different perspectives and across different years of birthing, I came to appreciate that perhaps if left alone a bit more then I would perhaps get a lot further into birth, further into labour and make it a whole lot better and smoother. (Consumer 5)
I moved from a fear of ‘what if’ to a bit more trusting the body and that nature would take its course…, which is very hard in a very medicalised system. I think weighing it all up having a little bit more knowledge and trust really helped me. (Consumer 5)I don’t feel the need for security of knowing where the baby is or security of what the heart rate is, I don’t feel that need … you just have to trust that you know, trust it’s going to go well and trust in your abilities that it will go well. (Consumer 9)
Doing it my way
I just wanted to do my own thing, in my own way so I could really focus and be able to do what I need to do as a birthing woman without having all the intrusion… I felt that if something was going to go wrong, that I would know, I’d feel it. (Consumer 2)Women know how to birth…and I trust in the natural process of birthing; women are actually capable and should not be told they can’t do it or that they are too slow…. These are the key things for me from my experience. The women can actually do it; they know how to actually give birth. (Consumer 3)
Women don’t want a midwife that has been trained in that technocratic model. They don’t want someone who has been trained in a hospital environment to observe hospital births and to manage birth using hospital resources and hospital mentality to come into their homebirth, which is counter, intuitive. They don’t want that. (Provider 9)
I didn’t particularly want that outside person coming into my home and me feeling like I had to welcome them in… I wanted that experience at home with my family, I wanted it to be intimate, I wanted it to be personal; I wanted to feel in control. (Consumer 6)It was significant that she came to my house. So the visit I felt it was very much on my terms, what ever happened, I felt very much in control about everything. And I really valued that. (Consumer 8)
Having a safety net
There were a few experienced doulas in the area where I live who attended free births who I trusted, but if anything was happening anything went wrong, they had the knowledge to help get me to the transport I needed… I had two doulas… I knew she had birth knowledge and backup there instead of just me and my partner being there alone. (Consumer 2)I was looking for moral support and someone out of the intensity of the moment to just recognise we need extra help or no you’re doing fine. I guess a professional opinion on how things were going. I would never attempt to birth without a knowledgeable person. I wouldn’t freebirth on purpose. I think having a doula provided me a bit of security that if something would be heading in the dangerous situation, off to the hospital we go. (Consumer 5)
I still like to call her a midwife and she says “I am not a midwife”, but the discussion we had was, I like to call you a midwife or lay midwife because in every sense of the word you are more a midwife than I am a registered birth worker. You can work with the woman whereas, of course the clinical stuff is very important… often it is seen as more important that the rest of the holistic care that the midwife does …I feel you are more of a midwife than I am because the expectation to use my clinical skills outweighs my right to practice my normal midwifery, which is being with the woman. (Consumer 6)
I loved the way she trusted birth completely and I liked the way she trusted birth so much she didn’t need to become a registered midwife… I felt very secure in her skills.. (Consumer 4)
Treated with love and respect versus the mechanical arm on the car assembly line
In my homebirth I was treated like a person who was part of the process. The main difference for me was, at home I was treated with love and respect, like I was important; like I was part of the process. I was treated like I was a real person. Whereas in hospital, I was treated like, I was a non-person. I was invalid and unimportant, less important that the machines that were hooked up to me …In my hospital birth I was treated like an inconvenience to the point where my midwife told me to stop vocalising because I was stressing her out. I was treated like the vehicle, which produces the result and the result being the baby. The baby being what’s important, the baby being the only thing that we are there for, the baby’s the product of the process. The product is what matters. I’m the mechanical arm on the car assembly line. (Consumer 9)
Respecting choices
I was looking for someone who wasn’t going to make me feel rushed and uncomfortable; I wanted someone who was going to respect my wishes and that was going to respect my preferences. (Consumer 3)A lot of birth workers who work as doulas, work as unassisted doulas and have a lot more trust in the birthing process. They are a lot more willing to allow the woman to make her own decisions rather than taking control and doing it themselves…So it’s passing the power back to the women rather than handing her power over to the midwife or the doctor or whoever, an obstetrician. Making sure the woman is empowered to make her own decisions. She knows what is best for her and her family if she is given the right information and allowed to make her own decisions. (Consumer 2)
Negotiated/flexible care feels safe
I chose her because I thought she certainly was in line with what I wanted. I thought she would support me 100% and I would be safe if I changed my mind or if something went wrong she would support me … It was amazing, she would do whatever so I could stay at home. She would come over at the drop of a hat, she would give me any information I wanted. She give me female companionship, (Consumer 3)She was very available to everything and flexible in every way. I remember in one antenatal meeting she would talk to my partner too and say, “Look just in case things happen fast then this is what you need to do”. I found that very empowering. That approach, this is your birth; this midwife client relationship is maybe a different one; maybe the fact she is not registered midwife; it’s more on an equal social basis with her. That respect was more equal and I felt more empowered. I had more responsibility and this was reflected by the way she said, “if things go fast or if I am not there fast enough or if the shoulders get stuck you can take your finger and do this”. (Consumer 8)
I think some people you meet you just get a vibe. You just get that feeling that it’s something special to be in her care. I just felt I want that, I wanted to be in her care…and you know the thing with my UBW, interestingly she really empowered me and gave me lots of autonomy but in the crucial moment of birth, I didn’t want autonomy, where just you were in that moment where you feel like your first child descending and like in that moment, she did mother me, you know. Yea, I am very lucky. (Consumer 8)
Not that obligation to conform
UBWs are not bound by regulations to work and the book keeping and that accountability to a higher power and all that sort of stuff. That affects our scope of what we can do…it’s just not having boxes to tick. That’s what women are looking for. (Provider 9)The midwives I know that are registered, they often are talking about the frustration of the way they want to serve women to be able to fit into the registration criteria. So in that case, the UBW doesn’t have to have that controlling criteria in the way that she has to abide by. She is not controlled by that medical system. (Consumer 5)
Because she wasn’t associated with the medical system, there wasn’t that feeling that I needed medical support. There was that deep trust that this was a really natural process that was happening…I didn’t need her to have a medical degree behind her to give birth to a baby. (Consumer 4)
As in individual and on a personal level it was wonderful. She is an amazing woman and very, very supportive emotionally and caring, vary knowledgeable. She gives a lot of confidence to the birthing woman that she can do it. (Consumer 7)