The role of unregulated birthworkers in Australia from the perspective of women and birthworkers

Abstract

In Australia, 97% of women give birth in hospitals and 2.4% in birth centres; very few (0.3%) have a planned homebirth. Gaining access to a planned homebirth supported by a midwife is a complex process. Few women choose to give birth at home without a registered midwife or doctor (freebirth). Coronial evidence has demonstrated that some women choose unregulated birthworkers (UBWs) who act like midwives during a birth at home. For the purpose of this study I also define these births as freebirths. The aim of this study was to explore the role of UBWs in Australia from the perspective of women and birthworkers to determine why some women choose UBWs to support them to give birth at home and why, and how, UBWs provide this service. There were four research questions. 1. Why do women choose UBWs to attend them during a freebirth and what are the experiences of women who accessed the service? 2. What is the training, practice and skills of UBWs and what does UBW care entail? 3. What are the views of UBWs about the care they provide to women? 4. What are the views of women and UBWs about proposed legislative changes in Australia that may make the services of UBWs unavailable? This study used a sequential exploratory mixed methods design and was conducted in two phases. It included a review of submissions made to the South Australian Government on changes to legislation regarding birth attendants, in-depth telephone interviews of women and UBWs and a survey of both women attended by UBWs at home and the attending UBWs. The theoretical frameworks used to underpin this study were a transformative paradigm and feminism. Maternity services need to ensure women’s care is humanised and that they can easily access registered midwives and place of birth options so they feel respected, safe and satisfied. Medical professionals need to acknowledge and respect women’s requests when they step outside guidelines and they need to negotiate alternative choices within the system to protect women’s human rights. Reducing unnecessary medical intervention and obtaining fully informed consent before medical procedures would go a long way to reducing the incidence of trauma for women. Expanding holistic, relationship-based models of midwifery care would help facilitate social, emotional, mental, cultural and physical safety for women. If these changes were to happen, women may be less inclined to seek options outside the system.

Date of Award	2020
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Hannah Dahlen (Supervisor)