Transfer from planned homebirth to hospital : views and experiences of women, midwives and obstetricians

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[Background] Recent evidence supports the safety of planned homebirth for low risk women when professional midwifery care and adequate collaborative arrangements for referral and transfer are in place. Much is known about rates of transfer, but little is known about the experiences of the women and caregivers involved. [Aim] The aim was to explore the views and experiences of women, midwives and obstetricians involved in the intrapartum transfer of women from planned homebirth to hospital in the Australian context. [Methods] Thirty-six semi-structured interviews were conducted with women, midwives and obstetricians. A constructivist grounded theory approach was taken to enable exploration of the social interactions and processes that occurred. [Findings] Four categories emerged from the analysis, ‘Fostering relationships and reducing uncertainty’, ‘Transferring out of the comfort zone’, ‘Us and them’ and ‘Celebrating a successful transfer’. The grounded theory, ‘Supporting woman centred care in homebirth transfer’, was synthesised by integrating findings grounded in the data with theoretical codes gained from intergroup conflict theory. Effective strategies of collaboration included mutual respect, supporting the midwife-woman partnership and regarding the transfer as a success of the system rather than a ‘failed homebirth’. The goal of a ‘healthy mother and a healthy baby’ was ostensibly shared by women and caregivers, however, arriving at a common definition of a ‘healthy mother and a healthy baby’ was less straightforward, due to the different paradigms of childbearing that converged on the birthing room of a transferred woman. [Discussion] From the perspectives of Australian law, healthcare policy and human rights, the woman is the only person with the authority to make informed decisions for the health and well-being of herself and her baby. Women’s personal definitions of ‘healthy’ are made in the context of their individual parameters of risk and safety, encompassing psychological, emotional, social, cultural and spiritual domains. These may be used to guide optimal care in the homebirth transfer context. [Conclusion] Synthesis of the social processes and interactions occurring during homebirth transfers enabled the formulation of a theoretical framework which may assist women to prepare for the possibility of transfer, and guide caregivers to understand and communicate complex issues that are unique to the homebirth transfer setting. The grounded theory ‘Supporting woman centred care in homebirth transfer’ may also have broader implications for collaboration in the maternity care milieu, especially in circumstances where a woman’s labour and birth follows an unexpected trajectory.
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