Commentary: Freebirthing: a case for using interpretative hermeneutic phenomenology in midwifery research for knowledge generation, dissemination and impact

Free or unassisted birth means a woman giving birth without medical or professional help (Birthrights, 2017; Nursing and Midwifery Council (NMC), 2012). It is not illegal for women to freebirth; however, it is illegal for another person to act as a midwife and perform skills such as vaginal examinations and fetal heart auscultation. In Britain, where the popularity of freebirthing is growing (NMC, 2012), this subject deserves more attention and discussion between midwives, service providers and policy makers. This research study therefore stimulates the debate surrounding freebirthing, the legalities, and the implications for practice for midwives and health professionals. It also revealed that there is currently no research evidence related to freebirthing in the United Kingdom (UK). This paper therefore adds to the body of research evidence for midwives, women, healthcare professionals, policy makers and service providers.

The use of interpretative phenomenology as a research methodology within midwifery is becoming much more widely used and accepted within the research arena. It is an excellent way of generating knowledge by exploring women’s in-depth experiences of a phenomenon such as freebirthing. Even though the particular group of women in this study are not generalisable to the whole population of women in labour, the findings may be transferable to similar women choosing to freebirth in the UK and therefore it needs to be acknowledged.

The findings of the study have implications for midwifery practice across the UK. They highlighted that midwives’ knowledge of the legalities of freebirthing was varied. Midwives were concerned about women making this choice as they want to support women with the birth and the immediate aftercare. Midwives and doctors need to try and unravel the complex reasons why women choose to freebirth. In order to preserve the safety of mothers and babies, there need to be open and honest discussions and opportunities for women to talk through options, to feel listened to and to make fully informed decisions. If women have had a negative or traumatic experience they need to be given the chance to de-brief and discuss their previous care, demonstrating that the issues are taken seriously and addressed appropriately. If women feel cared for and have trust in health professionals, they may be less likely to choose to birth without a midwife present. Better Births (NHS England, 2017) advocates that we offer women individualised and personal care providing continuity to support women with their choices and decision making.

This study highlighted that some women purposely delayed calling a midwife and gave birth before the midwife's arrival (BBA; birth at home before the planned arrival of a healthcare professional). However, the midwife arrived and the mother and baby were supported in the event of any issues arising. This could perhaps explain a reason for rising BBA rates. Having robust supportive and experienced home birth teams promoting safety could allay fears, gain confidence in midwives and reduce risk.

Women in the study reported that there were no ‘poor outcomes’; this may have contributed to their reasons for sharing their positive experiences. Policy makers and service providers need to be clear that this may not be the case for all women who choose to freebirth as there have been reported poor outcomes. Policy makers and service providers need to establish clear guidelines and protocols for freebirthing in order to ensure that midwives are familiar with the legalities, thus preventing unnecessary referral to safeguarding and social services and providing and planning care accordingly.

Dissemination of the findings of the study has used a variety of ways to reach as many health professionals as possible, increasing awareness and improving knowledge. This subject could therefore stimulate healthy debate amongst health professionals and help support women with their choices.

Biography

Cindy Shawley is a senior midwife and manager with a nursing background. She has a commitment and passion for continuing education and training and has a knowledge of research methodologies with advanced academic qualifications including a ‘Doctor of Clinical Practice'. She has designed and implemented sustainable award-winning service improvements to improve care for women and families.