I Got to Catch My Own Baby: A Qualitative Study of out of Hospital Birth

Purpose: About 1.5% of planned births in the United States occur out of hospitals. Recent studies have indicated that planned out-of-hospital birth (OOHB) is safe and satisfying for women, however, most women who have been included in studies of homebirth to date have been highly-educated, married, and white; little exists in the literature that would shed light on such birth options for African American women. Also missing from the OOHB literature are the voices of women survivors of abuse.  Stress is known to adversely affect the physiological processes of labor; as such, women who have experienced discrimination, childhood maltreatment and/or intimate partner violence may experience greater stress in the hospital setting, and may be motivated to seek care outside the system. Recently, some women are making the choice to have an OOHB, but are choosing to give birth without the aid of a midwife, as part of a movement called “unassisted birth” (“UAB”) or “freebirthing.” The purpose of this qualitative study is to fill a gap in understanding the reasons for choosing OOHB or UAB for two clinically important sub-groups of women: African-American women, and women who have experienced abuse (either childhood or adult physical or sexual abuse/molestation).

Methods: This study recruited 18 women who identified as having had an OOHB or UAB and were either African-American or survivors of sexual trauma to participate in in-depth qualitative interviews that included questions about the process of coming to the choice to give birth out of hospital. A grounded theory approach was utilized that involved a discursive process of data collection, coding textual passages to identify focused themes, memo writing to document analytic decision making, and eventual conceptual modeling and theory development. 

Results: Women have a multitude of reasons for choosing maternity care providers and place of birth. Results of focused coding suggests that some women may choose OOHB because of a previous trauma, or because they feel discriminated against by healthcare professionals, either because of race, age, pregnancy, weight, or some other health condition. Women may choose OOHB or UAB because it affords one to have more control during the process of giving birth. In the words of one study participant speaking about the importance of having control, “They didn’t have someone there telling them what to do or giving them permission to start pushing or I guess, my daughter’s birth really tainted me because I didn’t want anyone to give me permission to do something or not do something. Period. I wanted to be completely in control.”

Implications: Understanding the lived experiences of individuals at the edges of our maternity care system contributes to a larger conversation about the need for respectful maternity care, and fosters nascent efforts to institute trauma informed care in perinatal care systems. These data also help inform our clinical understanding of OOHB and UAB for professionals who work with pregnant women, including doctors, midwives, doulas, nurses, social workers, and psychologists, and may contribute more broadly to the national conversation about birth choices in the USA.