Relationships are the key to a successful publicly funded homebirth program, a qualitative study

Abstract

Background: In Australia, publicly-funded homebirth is a relatively new option for women and their families. Two years after the inception of two publicly funded homebirth services in Victoria in 2009, a study found that midwives' experiences were more positive than doctors. There is no recent evidence on the perspectives of midwives and doctors of publicly-funded homebirth programs.

Aim: To explore the experiences of midwives and doctors participating in or supporting one publicly-funded homebirth program in Australia.

Methods: An interpretive descriptive approach was used following individual in-depth interviews via 'Zoom'. Participants included midwives and doctors who provide or support the homebirth service at a large metropolitan health service in Melbourne's western suburbs. Data were thematically analysed.

Findings: Interviews were conducted with 16 homebirth midwives, six hospital-based midwives, and nine doctors. One central theme and three sub-themes demonstrate that effective relationships are critical to a successful publicly-funded homebirth program. Collaboration, teamwork, and mutual respect across professions were reported to be integral to success. The midwife-woman relationship was highly valued and especially important to provide continuity during transfers to the hospital where this occurred.

Discussion: Effective relationships underpin collaborative practice and are critical for safe healthcare. Shared common learning opportunities such as simulation training sessions and multi-professional forums to discuss cases were perceived to assist the development of these relationships.

Conclusion: Effective relationships within and between midwives and doctors are key to collaborative practice, which underpins a successful publicly-funded homebirth service. Health services can support this by maintaining a respectful and supportive culture amongst staff.

Keywords: Continuity of care; Home birth; Home care services; Hospital-based; Interprofessional relations; Midwifery; Pregnancy.