Against the grain: Midwives' experiences of facilitating homebirth outside of guidelines

Background: Midwifery standards promote autonomous decision making and informed choice, resulting in maternal homebirth choices which may contravene guidelines. There is a paucity of evidence exploring midwives experiences of managing these choices. Aims: To explore the lived experiences of midwives facilitating homebirth outside of guidelines. Methods: A qualitative design using an interpretive hermeneutic cycle to analyse semi-structured interviews. Findings: Participants reported confidence in supporting maternal choices, identifying barriers including other birth supporters. Perceived levels of risk, previous experience and safety concerns impacted on confidence. Peer, unit and Professional Midwifery Advocate (PMA) support were identified as being beneficial to midwives. Recommendations: Expansion of birth choices clinics; implementation of dedicated homebirth teams; guideline review for Midwife Led Birthing Units (MLBU); expansion of the PMA role; implementation of a structured de-briefing service and further research looking at women's choices and the impact of the loss of midwifery supervision.