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midwives

Support for home birth midwives caring for women with additional needs: a phenomenological study

02 June 2025
Research
02 June 2025
Volume 33 · Issue 6

Abstract

Background/Aims

More women with additional care needs now opt for home births outside of guidelines. This has led to a significant evolution in the role of the home birth midwife, which brings heightened complexities in the planning and delivery of care. Home birth midwives must adhere to organisational risk, management and governance frameworks while upholding their professional commitment to supporting physiological birth and providing woman-centred care. This study aimed to explore the lived experiences of midwives providing home birth care and examine the support systems that enable them to fulfil this autonomous role.

Methods

This phenomenological study recruited 6 purposively sampled home birth midwives through social media to take part in semi-structured interviews. Data were analysed thematically.

Results

There were three key themes: positive working teams, reflecting the value of cohesive collaboration; ‘because you're worth it’, highlighting investment in staff to foster effective and safe practice; and an overarching narrative of strong-enabling leadership, which underscored the importance of supportive and empowering leadership in shaping midwifery practice.

Conclusions

With the expansion of services to women outside of guidance, more investment is required for home birth midwives to support the specialist role they provide.

Implications for practice

To ensure that home birth midwives are supported to provide this specialist serviced, there should be identification of professional support networks available in the planning stage of a home birth outside of guidance and networks available in acute situations, or restoratively, post event.

Information and choice regarding place of birth should be offered to all pregnant women (National Institute for Health and Care Excellence (NICE), 2023), with emphasis that birth in the UK has never been safer (Bisits, 2016). Home birth is a valid, evidence-based option for healthy women with uncomplicated pregnancies (Brocklehurst et al, 2011; Hutton et al, 2019). Women with additional needs are contraindicated to birth at home because of increased risks for either the woman or baby during or shortly after birth (NICE, 2023). UK maternity policy prioritises safe, personalised and woman-centred care throughout the perinatal period (NHS England, 2016), with midwives professionally mandated to advocate for women's choices and provide personalised care (Nursing and Midwifery Council (NMC), 2018), in alignment with Article 8 of the Human Rights Act (1998), which protects care that may diverge from medical recommendations.

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Additional care needs
Home birth
Midwifery leadership
Midwives' experiences
Support for midwives