An interpretative phenomenological study of midwives supporting home birth for women with complex needs
As the landscape of women presenting for maternity care changes, so do the challenges associated with providing quality, informed and compassionate care, particularly for women with complex needs.
To explore the lived experience of midwives in facilitating care for women with complex needs who choose to birth at home.
A qualitative design is employed, using an interpretative phenomenological analysis informed by hermeneutic principles. Purposive sampling is used to recruit midwives through social media and JiscMail. Data are collected via semi-structured interviews.
Two interpretative themes arose. A ‘radical midwife’ embraces the phrase ‘radical’ by positioning midwives between traditional beliefs and practices, physiological processes, midwife knowledge and skill set by applying current evidence and professional context. A ‘conflicted midwife’ arises out of this dichotomy and exposes the realities of striving for radicality while the negotiating ‘the system’.
It is no longer acceptable to assume that home birth for women with complex needs is exceptional. This must be the catalyst to move towards a constructive discourse with midwives, women and the wider team to address and expand the evidence base and pathways to support those who are already facilitating this care and those who will inevitably continue to provide care ‘outside of current guidelines’.
The landscape of women presenting for care in pregnancy now compared to the 1970s is vastly different thanks in part to the development of technologies which support women with comorbidities, significant and complex mental health, obstetric, social and physical needs. Women who present with complex needs remain well informed and with the rise of social media, are finding that their voice is strong - as individuals and as a collective. Better Births (National Maternity Review, 2016) expounded a vision for maternity care which firmly places the woman and her family at the centre of care, supporting choice, control and autonomy, and ensuring that midwives deliver responsive care, allow informed decision making and choices, and exemplify these as a fundamentally embedded concept and cornerstone in modern maternity service provision.
An evidence base exploring women's reasons for birth choices outside of conventional advice is growing, with a view to contributing not only a deeper understanding of these motivations, but also informing how health care professionals can support such women. What is less understood is the experiences of midwives who support women with complex needs who choose to birth at home.
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