Home Birth and Freebirth: Supporting Women’s Choices Who we are? Why is this issue important? Cathy Brewster and Kati Edwards Beyond Consent, Supporting Women’s Choices 2016 Salford Midwifery Society Twitter: @MancHomebirth @KatiBYIL

Why Is This Important? NICE Guidance CG190 says women: Women may choose any birth setting and; Support them in their choices Who we are? Why is this issue important?

(Planned or Unplanned) 2% of UK women birth at HOME (Planned or Unplanned) ONS, 2015 3

…though 10% would like to! (National Federation of Women’s Institutes, 2013)

WHY HOME BIRTH? EXERCISE 1: Shout Out 3 minutes – SHOUT OUT BY UNDERSTANDING WOMENS REASONS FOR HOMEBIRTH, THIS CAN HELP YOU TO SUPPORT THEM

From Greater Manchester Hombirth Support Group. Download from website.

EXERCISE 2: DISCUSS IN PAIRS : Woman: “I’m thinking about having a home birth” It might influence her decision Language may really affect her How do you feel? What might you say? How does what you feel and say affect her?

How might these responses affect the woman? #REAL LIFE STORIES NOTE: Different women will respond differently to these responses depending on how hard/sensitive/ informed/ hormonal she is etc. How might these responses affect the woman?

Negative Experiences I’d like a home birth… We asked for the experiences sample on The Home Birth Chat Group (FB).

Positive Experiences I’d like a home birth… We asked for the experiences sample on The Hone Birth Chat Group (FB).

Are we a BLANK canvass? NICE Guidelines CG190, 2014 1.1.9 When discussing the woman's choice of place of birth with her, do not disclose personal views or judgements about her choices. [new 2014] Discussion around this. A blank canvas? Think about what we’re giving off and how that affects the woman. From the NICE guidelines. Information should be given in an unbiased way NICE Guidelines CG190, 2014

FREE BIRTH/ UNASSISTED BIRTH

Is it legal to birth in the UK without a midwife? Questions: Is it legal to birth in the UK without a midwife? Yes!

Should midwives support freebirth? Questions: Should midwives support freebirth? (RCM poll) RCM SURVEY 2008: Should Midwives support freebirth? 80% No 20% Yes

EXERCISE 3: Shout Out WHY FREE BIRTH? 3 minutes – SHOUT OUT

Freebirth Research 1 Contextualising herstory Diverging paths of decision making Converging paths of decisiom making Freeley, C. and Thomson, G. (2016) (Why do some women choose freebirth in UK? An interpretive phenomenological study, BMC Pregancy and Childbirth Claire Feeley soon to be published paper

Freebirth Research 2 Risk discourse; ‘manipulative and coercive’ Risk discourse can lead to a loss of trust and avoidance of maternity services Fearful mood in maternity services leads to ‘dehumanisation’ of the woman Talk about mortality raises existential concerns which are unmet by health services Risk and Fear in the Lived Experience of Birth Without a Midwife, Kirkham & Plested (2016) Mariamni Plested, Mavis Kirkham Author’s Accepted Manuscript Risk and fear in the lived experience of birth without a midwife as yet unpublished Accepted by Midwifery A purposeive qualitative study with 10 participants recruited by social media.

16 Ways To Best support HB/FB? SUPPORT CHOICE NO MATTER WHAT! Know it’s NOT your choice; it’s not your call Be Non-Judgmental about their choices Never say no or limit options based on history State FACTS (Don’t scaremonger or threaten poor outcomes) Know your research, guidelines & current opinions Inform your woman; communicate effectively Discuss potential complications, reasons for tranfers antenatally Conclusion 3 each

16 Ways To Best support HB/FB? Co-create birth plans enabling women to be active agents in their decisions Explain that all decisions and choices are the woman’s responsibility Continuity of care builds relationship and trust Understand her reasons; discover her actual fears Language matters; eliminate jargon: e.g. Meaning of “significant” Documentation is important; and will protect your registration Be assertive with colleagues; advocate for your woman Seek support from supervisiors and team leaders Conclusion

The Midwife’s Juggling Act “As a midwife, you have to balance supporting women with retaining your pin and reputation and your own mental well-being. It’s a juggling act and it’s not easy” Midwife Anon Informed consent rather than based on fear

May your choices When information is given, don’t scare people.

Thanks for participating! Twitter: @MancHomebirth @KatiBYIL