A survey of women in Australia who choose the care of unregulated birthworkers for a birth at home

Background: Anecdotally, the number of Australian women who choose unregulated birthworkers to support a homebirth without a registered midwife present is increasing. Aim: To explore the experiences and reasons why some women choose unregulated birthworkers for a homebirth, and examine what they might do if changes in legislation removed this choice. Methods: A survey was distributed via social media networks and data were analysed using descriptive statistics. Content analysis was undertaken on open-ended questions. Findings: Eighty-two women completed the survey. Most reported they achieved an undisturbed homebirth with a flexible carer who provided continuity of care and respect for their choices irrespective of risk factors. Three women whose babies died described their homebirth with an unregulated birthworker as the worst experience of their life. Motivators for choosing an unregulated birthworker to support homebirth were: previous negative and traumatising birth experiences; limited choice; and lack of access to midwifery led models of care within mainstream services. Only a third of the women in this study said they would birth in a hospital if legislation prevented their access to an unregulated birthworker's support for a future birth. Conclusion: Maternity services in Australia do not meet all women's needs, leaving some feeling no other option exists but to seek an unregulated birthworker to support a homebirth. Previous negative experiences with maternity healthcare providers, inflexible systems of care, and limited access to funding for homebirth with privately practising midwives were identified as motivating factors. These issues require solutions to prevent homebirth going underground.