Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study

Rigg, Elizabeth Christine and Schmied, Virginia and Peters, Kath and Dahlen, Hannah Grace (2017) Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study. BMC Pregnancy and Childbirth, 17 (1).

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In Australia the choice to birth at home is not well supported and only 0.4% of women give birth at home with a registered midwife. Recent changes to regulatory requirements for midwives have become more restrictive and there is no insurance product that covers private midwives for intrapartum care at home. Freebirth (planned birth at home with no registered health professional) with an unregulated birth worker who is not a registered midwife or doctor (e.g. Doula, ex-midwife, lay midwife etc.) appears to have increased in Australia. The aim of this study is to explore the reasons why women choose to give birth at home with an unregulated birth worker (UBW) from the perspective of women and UBWs.


Nine participants (five women who had UBWs at their birth and four UBWs who had themselves used UBWs in the past for their births) were interviewed in-depth and the data analysed using thematic analysis.


Four themes were found: ‘A traumatising system’, ‘An inflexible system’; ‘Getting the best of both worlds’ and ‘Treated with love and respect versus the mechanical arm on the car assembly line’. Women interviewed for this study either experienced or were exposed to mainstream care, which they found traumatising. They were not able to access their preferred birth choices, which caused them to perceive the system as inflexible. They interpreted this as having no choice when choice was important to them. The motivation then became to seek alternative options of care that would more appropriately meet their needs, and help avoid repeated trauma through mainstream care.


Women who engaged UBWs viewed them as providing the best of both worlds – this was birthing at home with a knowledgeable person who was unconstrained by rules or regulations and who respected and supported the woman’s philosophical view of birth. Women perceived UBWs as not only the best opportunity to achieve a natural birth but also as providing ‘a safety net’ in case access to emergency care was required.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Faculty / Department / School: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery
Date Deposited: 25 Jan 2018 05:20
Last Modified: 04 May 2018 04:47
Uncontrolled Keywords: homebirth, doula, birth worker, midwives, regulation
Fields of Research : 11 Medical and Health Sciences > 1110 Nursing > 111006 Midwifery
Socio-Economic Objective: C Society > 92 Health > 9202 Health and Support Services > 920210 Nursing
C Society > 92 Health > 9202 Health and Support Services > 920208 Health Policy Evaluation
Identification Number or DOI: 10.1186/s12884-017-1281-0
URI: http://eprints.usq.edu.au/id/eprint/33530

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