When the Hospital Is No Longer an Option: A Multiple Case Study of Defining Moments for Women Choosing Home Birth in High-Risk Pregnancies in The Netherlands

Some women in a high-risk pregnancy go against medical advice and choose to birth at home with a “holistic” midwife. In this exploratory multiple case study, grounded theory and triangulation were employed to examine 10 cases. The women, their partners, and (regular and holistic) health care professionals were interviewed in an attempt to determine whether there was a pattern to their experiences. Two propositions emerged. The dominant one was a trajectory of trauma, self-education, concern about paternalism, and conflict leading to a negative choice for holistic care. The rival proposition was a path of trust and positive choice for holistic care without conflict. We discuss these two propositions and make suggestions for professionals for building a trusting relationship using continuity of care, true shared decision making, and an alternative risk discourse to achieve the goal of making women perceive the hospital as safe again.

[1]  J. van Dillen,et al.  Women’s motivations for choosing a high risk birth setting against medical advice in the Netherlands: a qualitative analysis , 2017, BMC Pregnancy and Childbirth.

[2]  S. Kruske,et al.  The experiences of women, midwives and obstetricians when women decline recommended maternity care: A feminist thematic analysis. , 2017, Midwifery.

[3]  A. Kotaska.  Informed consent and refusal in obstetrics: A practical ethical guide , 2017, Birth.

[4]  K. Sarma,et al.  What about me? The loss of self through the experience of traumatic childbirth. , 2017, Midwifery.

[5]  M. Lukasse,et al.  Factors related to a negative birth experience - A mixed methods study. , 2017, Midwifery.

[6]  F. Chervenak,et al.  The unlimited‐rights model of obstetric ethics threatens professionalism , 2017, BJOG : an international journal of obstetrics and gynaecology.

[7]  J. van Dillen,et al.  Preventing traumatic childbirth experiences: 2192 women’s perceptions and views , 2017, Archives of Women's Mental Health.

[8]  C. Roberts,et al.  “Very Good” Ratings in a Survey of Maternity Care: Kindness and Understanding Matter to Australian Women , 2017, Birth.

[9]  M. Butler,et al.  A participatory action research study exploring women's understandings of the concept of informed choice during pregnancy and childbirth in Ireland. , 2017, Midwifery.

[10]  R. Sharman,et al.  Women’s descriptions of childbirth trauma relating to care provider actions and interactions , 2017, BMC Pregnancy and Childbirth.

[11]  G. Thomson,et al.  Tensions and conflicts in 'choice': Womens' experiences of freebirthing in the UK. , 2016, Midwifery.

[12]  L. Holten,et al.  Women׳s motivations for having unassisted childbirth or high-risk homebirth: An exploration of the literature on 'birthing outside the system'. , 2016, Midwifery.

[13]  T. Lagro-Janssen,et al.  Women refusing standard obstetric care: maternal fetal conflict or doctor-patient conflict? , 2016 .

[14]  L. Forbat,et al.  Developing the DESCARTE Model , 2016, Qualitative health research.

[15]  Peter N. Rule,et al.  A Necessary Dialogue , 2015 .

[16]  J. Morse.  Critical Analysis of Strategies for Determining Rigor in Qualitative Inquiry , 2015, Qualitative health research.

[17]  A. Baart,et al.  Demarcation of the ethics of care as a discipline , 2014, Nursing ethics.

[18]  R. Stake,et al.  Science of the Particular , 2014, Qualitative health research.

[19]  R. Chadwick,et al.  Negotiating risky bodies: childbirth and constructions of risk , 2014 .

[20]  I. Aune,et al.  The woman's birth experience---the effect of interpersonal relationships and continuity of care. , 2013, Midwifery.

[21]  R. Thomson,et al.  Shared Decision Making: A Model for Clinical Practice , 2012, Journal of General Internal Medicine.

[22]  M. Barry,et al.  Shared decision making--pinnacle of patient-centered care. , 2012, The New England journal of medicine.

[23]  G. Elwyn,et al.  Shared decision making: really putting patients at the centre of healthcare , 2012, BMJ : British Medical Journal.

[24]  L. Ledderer.  Understanding Change in Medical Practice: The Role of Shared Meaning in Preventive Treatment , 2011, Qualitative health research.

[25]  W. Kernohan,et al.  New midwifery? A qualitative analysis of midwives' decision-making strategies. , 2007, Journal of advanced nursing.

[26]  E. Brink,et al.  Constructing grounded theory : A practical guide through qualitative analysis , 2006 .

[27]  S. H. Ali,et al.  Risk and Everyday Life , 2005 .

[28]  L. D. de Witte,et al.  Recognition of client values as a basis for tailored care: the view of Dutch expert patients and family caregivers. , 2005, Scandinavian journal of caring sciences.

[29]  C. Barry.  Multiple Realities in a Study of Medical Consultations , 2002, Qualitative health research.

[30]  G. Elwyn,et al.  One hundred years ago: Should milk be boiled? , 2002, BMJ : British Medical Journal.

[31]  A. DeBaets.  From birth plan to birth partnership: enhancing communication in childbirth. , 2017, American journal of obstetrics and gynecology.

[32]  Christine Nadel,et al.  Case Study Research Design And Methods , 2016 .

[33]  Peter McLaren,et al.  Critical pedagogy and qualitative research: moving to the bricolage , 2011 .

[34]  Judith Green,et al.  Qualitative methods for health research , 2004 .