School of Nursing and Midwifery, Western Sydney University, Locked bag 1797, Penrith, NSW, 2751, Australia.
BMC Pregnancy Childbirth. 2020 Apr 28;20(1):254. doi: 10.1186/s12884-020-02944-6.
Childbirth in Australia occurs predominantly in a biomedical context, with 97% of births occurring in hospital. A small percentage of women choose to birth outside the system - that is, to have a midwife attended homebirth with risk factors, or a freebirth, where the birth at home is intentionally unattended by any health professional.
This study used a Grounded Theory methodology. Data from 13 women choosing homebirth and 15 choosing freebirth were collected between 2010 and 2014 and analysed over this time.
The core category was 'wanting the best and safest,' which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was 'finding a better way'. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies.
Shortfalls in the Australian maternity care system is the major contributing factor to women's choice to give birth outside the system. Systematic improvements should prioritise humanising maternity care and the expansion of birth options which prioritise midwifery-led care for women of all risk.
澳大利亚的分娩主要发生在生物医学背景下，97%的分娩发生在医院。一小部分女性选择在系统外分娩——也就是说，有风险因素的情况下由助产士在家中分娩，或者自由分娩，即在家中分娩时故意没有任何卫生专业人员在场。
本研究采用扎根理论方法。2010 年至 2014 年间收集了 13 名选择在家分娩和 15 名选择自由分娩的女性的数据，并在此期间进行了分析。
核心类别是“想要最好和最安全的”，这描述了促使女性选择在系统外分娩的动机。解释女性追求最好和最安全的途径的基本社会过程是“寻找更好的方法”。在澳大利亚，选择在系统外分娩的女性有反文化的信念，即她们对什么是最好和最安全的知识比社会公认的产妇护理专家更有权威。这些女性不相信医院安全性的言论，并认为与在系统外分娩相比，生物医学方法分娩的风险更大。之前的分娩经历让女性们认识到医院护理在情感上不安全，如果她们回到医院，可能会有进一步的创伤。在系统外分娩为女性提供了她们认为是为自己和宝宝提供最佳和最安全环境的机会。
澳大利亚产妇保健系统的缺陷是导致女性选择在系统外分娩的主要因素。系统改进应优先重视人性化的产妇保健，并扩大以助产士为主导的分娩选择，优先为所有风险的女性提供护理。
