Motivations and influences acting on women choosing a homebirth: Seeking a ‘cwtch’ birth setting
The opportunity to have a homebirth in the UK is highly regarded by both women and midwives. However, few women avail themselves of this birth option. Appreciating the multifarious explanations for why this is the case is fundamental to understanding the situation. Factors that motivate women surrounding homebirth include: past experience; beliefs about childbirth and motherhood; and external and interpersonal influences. This article reviews the influences that affect women when deciding on a homebirth. The authors support the idea that fundamental drivers operate; essentially, women are seeking places of emotional and physical safety for birth. This phenomenon is difficult to encapsulate in one English word, but other languages express this concept well. We borrow a popularised word (used as a noun and verb) from the Welsh lexicon to summarise ideas about women's desires regarding place of birth: in effect, women are seeking a cwtch birth setting.
In the UK, only a small number of women have a homebirth. Recent birth figures report that, on average, 2.3% of women gave birth at home in England and Wales (Office for National Statistics (ONS), 2015). The gradual shift from domiciliary to hospital birth witnessed in the early decades of the 20th century gathered pace in the early 1960s, reaching a nadir for homebirth by 1974 (Nove et al, 2008). Since the 1980s, there has been a small but sustained increase in the number of planned homebirths among certain groups of women. Why some women choose and others decline homebirth is unclear. Given the complexities of women's reproductive lives, it is important to understand what motivates women to make particular choices about birth setting. Doing this could enable midwives to better meet women's needs and advance opportunities for promoting homebirth. This narrative overview (Green et al, 2006) of recent research, professional commentary and policy literature explores personal motives, interpersonal influences and external influences on women's decisions about homebirth. This article proposes a novel phrase using a word from the Welsh English vernacular, known as ‘Wenglish’ (Lewis, 2016), that we suggest serves to describe the essential desires of many women when they choose their birth setting.
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