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Experiences of Women Who Have Planned Unassisted Home Births: a Systematic Review Protocol

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Experiences of Women Who Have Planned Unassisted Home Births: a Systematic Review Protocol SYSTEMATIC REVIEW PROTOCOL Experiences of women who have planned unassisted home births: a systematic review protocol 1 1 2,3 Danielle Macdonald Josephine Etowa Melissa Helwig 1School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada, 2W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada, and 3Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence Review question/objective: The objective of this review is to identify, appraise and synthesize the qualitative evidence on the experiences of women in high resource countries who have planned unassisted home births. This qualitative review aims to answer the following question: what are the experiences of women who have planned unassisted home births? Keywords Freebirth; unassisted birth; unassisted home birth JBI Database System Rev Implement Rep 2019; 17(1):16–21. Introduction urging of physicians for reasons such as safety and 11 here are many decisions that women and family hygiene. This new, innovative medical model of birthing in hospitals slowly became normative after T members face as they prepare for the birth of a 12 new child. Place of birth and the type of healthcare World War II. As women and families came to provider for perinatal care are two common consid- associate hospital birth with safety, their interest and erations for women and families. For many women, trust in home births dwindled. In countries like a hospital is the preferred location for labor and Canada and the United States, in the 1970–80 s delivery, attended by a physician.1 Increasingly, in the home birth movement emerged in response to high resource countries,2,3 women and families are the misuse of obstetrical interventions, less than ideal birthing experiences and lack of choice for non- choosing to have midwifery care and home births 12 attended by midwives.4 normative ways of birthing. With the home birth For an unknown number of births, women and movement came renewed interest in choice of birth their families are choosing to have home births place and choice of healthcare provider, with women without the assistance of a healthcare provider. and parents deciding where and with whom they These births are referred to as; unassisted wished to have their birthing experience. 1,5-8 1,5,9 1 The term ‘‘unassisted birth’’ was first coined by births, free births, autonomous births, 13 unhindered births,1 and do-it-yourself births.5 For Laura Kaplan Shanley. Unassisted birth can be described as birth where there is an ‘‘absence of this systematic review of qualitative literature, the 1(p.54) term ‘‘unassisted birth’’ will be used as it is the most an expert, rather than complete solitude’’. commonly used term across countries in the global Unassisted birth has also been described as ‘‘a unique north to refer to this phenomenon.1 phenomenon, whereby women make an active choice not to utilize the maternity services that are Prior to the early and middle twentieth century, 7(p.4) depending on the high resource country, most available to them’’. It is very important to women gave birth in their homes.10,11 Birthing care distinguish unassisted birth from the phenomenon moved from taking place in homes to taking place in referred to as ‘‘born before arrival’’ which occurs hospitals in many high resource countries with the when a birth happens with the unintentional absence of attendance by a healthcare provider.7 An example of a ‘‘born before arrival’’ birth would be if a woman Correspondence: Danielle Macdonald, experienced an extremely fast labor and did not have [email protected] time to seek assistance from a healthcare provider. There is no conflict of interest in this project. This is different from an unassisted birth because DOI: 10.11124/JBISRIR-2017-003654 ’’born before arrival’’ birth occurs as a result of not JBI Database of Systematic Reviews and Implementation Reports ß 2018 THE JOANNA BRIGGS INSTITUTE 16 ©2019 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited. SYSTEMATIC REVIEW PROTOCOL D. Macdonald et al. having enough time to access healthcare, whereas in process, iii) autonomy, and iv) agency.7 The first two the case of an unassisted birth, there is an active reasons are self-explanatory. The third reason has to choice not to seek care from a healthcare provider. It do with the preservation of a woman’s autonomy is also important to understand that although an and her control over the birthing experience, which unassisted birth often takes place in the home, it was often related to a previous birthing experience should not be confused with a home birth. A home during which the woman felt a lack of control.7 The birth is a birth that is attended by a healthcare final reason had to do with a woman maintaining provider, usually a midwife, who is present during agency over her own body and the birthing process, labor, delivery and the immediate postpartum. through the decision to reject a medicalized birth.9 It is difficult to know the exact prevalence of This synthesis7 focused on what influenced women unassisted birth throughout the world because of to choose to have an unassisted birth; however, it did the nature of it taking place at the margins of the not explore and synthesize the literature1,8,9,14,15 healthcare system. Plested and Kirkham14 stated the about the actual experiences that women had during lack of data regarding unassisted birth in the United unassisted births. Kingdom, while Lindgren, Nassen, and Lundgren8 For this systematic review, we are interested in stated that one in five home births in Sweden are understanding the experiences of women who unattended by a midwife or a healthcare provider. It choose unassisted birth in high resource countries.2,3 is difficult to know whether the lack of data on The reason for this is because in high resource unassisted birth is due to the methods for collecting countries, perinatal care is generally available to data on out-of-hospital birth or whether the lack of women. Thus, the women choosing to have unas- data reflects the low numbers of women and families sisted birth are making a choice that challenges the choosing this as a birthing alternative. mainstream expectations of birthing with the assis- Studies have suggested that there is stigma asso- tance of a healthcare provider. In under-resourced ciated with making healthcare decisions that contra- countries, women and families may birth at home dict mainstream healthcare, such as the decision to without the assistance of a healthcare provider due have an unassisted birth.6,9 The presence of stigma to a lack of perinatal services, shortage of skilled surrounding the decision to have an unassisted birth birth attendants, and financial or infrastructure bar- may contribute to the challenge in accounting for the riers to access any services that do exist. The differ- number of women and families choosing such alter- ences in the accessibility of perinatal care between natives as home birth or unassisted birth.6 According high resource countries and low resource countries to Miller,6 women who chose unassisted birth often may result in different reasons why women choose to strategized how they were going to address the birth at home without the assistance of a healthcare layered stigma of an unassisted birth. For these professional. In this qualitative systematic review, women, unassisted birth was associated with two we are interested in understanding the experiences of layers of stigma; the first layer was one from main- women who choose unassisted births, within a con- stream society for choosing to have a birthing expe- text of generally accessible perinatal care. rience outside of accepted norms, the second layer This systematic review will synthesize findings as was from home birth advocates who supported they relate to women’s experiences of unassisted home birth, but not home birth without the assis- birth. Understanding women’s experiences of unas- tance of a healthcare provider.6 Miller6 argued that sisted birth may assist us in our understanding of this double layer of stigma rendered women and what women value in their experiences of birth, families who chose unassisted birth invisible. generally. The findings of this review may also assist Through this example, we can see the challenges us in identifying important elements of care that are in accounting the prevalence of unassisted birth missing from mainstream perinatal services. within the general population. A preliminary search of MEDLINE/PubMed, A meta-thematic synthesis which examined why CINAHL, the Cochrane Database of Systematic women choose to have an unassisted birth revealed Reviews and the JBI Database of Systematic Reviews four main reasons.7 The reasons for choosing an and Implementation Reports revealed that there are unassisted birth included; i) rejection of the medical currently no published systematic reviews about and midwifery models of birth, ii) faith in the birth women’s experiences of unassisted birth. Both JBI Database of Systematic Reviews and Implementation Reports ß 2018 THE JOANNA BRIGGS INSTITUTE 17 ©2019 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited. SYSTEMATIC REVIEW PROTOCOL D. Macdonald et al. PROSPERO and the Campbell Collaboration were be utilized in this review. An initial limited search of also checked. In PROSPERO, two results were iden- PubMed and CINAHL will be undertaken followed tified regarding outcomes and place of birth.16,17 by analysis of the text words contained in the title Other results concerned decision making around and abstract, and of the index terms used to describe birth18,19 and during pregnancy and birth.20 None each article (see Appendix I for preliminary search of the results in PROSPERO examined the experi- strategy).
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