What do safety and risk mean to women who choose to birth at home? A systematic review.

Introduction: Despite clear evidence to support the safety and efficacy of homebirth, the concept challenges the almost universal belief that hospital is the safest place to give birth. Homebirth remains largely unsupported around the world due to prevailing beliefs and constructs surrounding risk and safety. Despite barriers to access, women continue to choose home as a place to birth.

Methods: A systematic review of qualitative research was conducted to explore and understand women's views on what constitutes risk and safety in labour and birth for those who choose to birth at home. All studies were evaluated for quality and relevance. Reflexive thematic analysis was used to identify themes.

Results: Analysis of the 29 papers included in this review identified three main themes: risk of hospital birth, risk of homebirth, and safety of homebirth, and convey that women who choose to birth at home view their social, emotional, psychological and spiritual safety as highly important, with homebirth protecting and respecting these factors. For the women in the studies we reviewed, physical safety was enhanced through having the expertise of a midwife present at their birth. Participants considered the cultural paradigm within hospital services to focus on care for the physical body and not the whole person, which had the potential to cause psychological and physical harm.

Discussion: This review demonstrated that women who choose to birth at home assess risk and safety differently to the way health care institutions assess these parameters. These findings will be of interest to maternity services and educators of maternity care practitioners.