Speaker
Description
High rates of intervention in birth is a significant health issue. In New Zealand, a primary birthing centre is a site for assessment, labour/birth and post-natal care close to home. These centres are midwife-led, supporting normal birth in an environment free from intervention that encourages active labour. Yet less than ten percent of NZ women birth in a primary birthing centre. We consider, how can primary birthing centres build confidence in primary birth? In-depth interviews were undertaken with 24 health care workers at four successful primary birthing centres. The findings demonstrate that ontological beliefs about birth are critical in shaping where the Māmā – and midwife – feel safe birthing. Medicalised beliefs about birth were observed to be self-fulfilling; in the face of entrenched beliefs, midwives adopted a relational approach, scaffolding the sharing information over the course of their client’s pregnancy. Participants discursively and visually re-centred birth as a normal physiological event by shifting conversations about pharmaceutical pain relief to natural options, avoiding negative comparisons with hospital. Birth was framed as a process that affords staff the time to manage labour deviating from normal thus minimising clients’ fears, such as distance from hospital. The use of reflexive thematic analysis identified midwives’ respect for entrenched worldviews that impacted where the Māmā felt safe birthing. Midwives’ experiences that labour progresses where Māmā feel safe reflect a neurohormonal understanding of labour that was evident in the qualities of the birthing centre. Our findings demonstrate the implications of growing rates of intervention in labour on birth place decision making.
Keywords: Place, qualitative, reproductive health, primary birth
