Table 1 Analysis Framework
Analytic theme | Descriptive theme | Codes | Description |
|---|---|---|---|
Lack of knowledge about what home birth looked like | What does home birth look like? | Familiarity Experience | - (Limited) Familiarity with concept of home birth - Perceptions that homebirth may influence experience (i.e. potential offers a better experience, but home linked to negative associations if things ‘go wrong’) |
Practicalities | - Uncertainty about the practicality, cost, consequences of home-birth | ||
Aftercare | - Concerns about reduced postnatal care after a home birth | ||
Expectation of birth in an OU | Assumption’ that they would give birth in an OU | OU ‘normal’ Cultural norms | - OU described as ‘normal’/‘usual’ place of birth - Participants describe making decisions in reference to cultural norms |
Option/choice | - Homebirth is an option rarely (or not) offered/discussed | ||
OU perceived as safer than home | High Risk OU safe Managing emergencies | - Birth described as carrying significant risk - OU described as safer option compared to home birth (minimizes risk) - OU considered to have greater ability to respond to emergencies/provide specialist staff | |
Lack of confidence in the reliability of the maternity service | Confidence in service at time of birth | Safety | Concerns about ability of maternity services to provide - safe birth at home |
Responsiveness | Concerns about ability of maternity service to be - available for home birth when required | ||
Accessibility | - Concerns about ability of maternity services to provide safe birth at home - Concerns about ability of maternity service to be available for home birth when required - Perceptions that maternity services are under-funded/under-resourced to provide appropriate level of care | ||
Continuity in care | Continuity | - Concerns that would not receive adequate aftercare (including breastfeeding support) | |
Perceptions of birth as a ‘natural’ event | Perceptions of ‘Natural Birth’ | Assistance | - Differing perceptions/meanings related to ‘natural’ birth linked to level of intervention |
Place | - Differing perceptions/meanings related to ‘natural’ birth linked to place (hospital vs home) | ||
Medical technology | - Differing perceptions on the role of medical technology in having a natural birth (safe/clean vs intrusive) | ||
Sources of information for women | Sources of information for women | Mode | - Mode of information - Information from people valued more than information leaflets |
Credibility | - Role of informants matters (having professionals experience of home birth and ‘like minded’ people are seen as credible) | ||
Formality | - Influence of formal routes (hospital antenatal classes, hospital tours) | ||
Informal Prioritization | - Role of family, friends in providing information - Home birth not prioritized | ||
The role of health care professionals | The role of health care professionals | Credibility | - Role of Health professionals – seen as credible source of information |
Gatekeepers | - HPs described as consciously and unconsciously controlling (restricting) information about place of birth | ||
Influence | - HPs seen as explicitly and implicitly influencing decision-making (skewed to OU as place of birth) | ||
Women’s responses to the offer of choice | Perception of choice | Choice – realities | - Preferred choices not always available (e.g. alternative options not given, or unable to be delivered in practice) |
Choice – acceptance | - Extent to which lack of choice is perceived by women to be acceptable (e.g. most women accepting of limited choice) | ||
Choice- skills | - Exerting choice for home birth requiring special skill sets e.g. ‘confidence’ and ‘motivation’ | ||
Response to choice | Responsibility | - Choice experienced as a responsibility (unwanted by many) | |
Rights to choose | - Choice sometimes needs to ‘fought’ for if it does not align to ‘usual’ routes | ||
Support | - Lack of support experienced for choices made (from family, health professionals) |