Staying Home to Give Birth: Why Women in the United States Choose Home Birth

Debora Boucher, CNM; Catherine Bennett, RNC, BSN; Barbara McFarlin, CNM, PhD, RDMS; Rixa Freeze, PhD, MA

Disclosures

J Midwifery Womens Health. 2009;54(2):119-126. 

In This Article

Methods

Study Design

This qualitative descriptive study sought to examine why women in the United States choose home birth. The study consisted of a secondary content analysis of one question from a larger dataset collected for a study entitled, "A New Look at Homebirth in the United States," by Rixa Freeze at the University of Iowa. The Institutional Review Boards at the University of Illinois at Chicago (UIC) and the University of Iowa reviewed and approved the study's intent and protocol. The online survey was advertised via e-mails and postings on Internet electronic mailing lists for childbirth professionals and via direct solicitations to known childbirth professionals who provide home birth services. Solicited home birth providers forwarded the advertisement to their patients, requesting volunteers to respond to the survey, which was made available online from August 2006 through May 2007. The data were collected in an Excel spreadsheet. After the survey was closed, the data were de-identified and provided to the UIC research team.

The conceptual framework that guided this research was Leininger's cultural care diversity and universality theory.[21] The goal of Leininger's theory is to "provide culturally congruent nursing care in order to improve or offer a different kind of nursing care service to people of diverse or similar cultures."[21] This theory applies to the subjects of our study because the small population of women who choose home birth could be considered a cultural group.

Essential to Leininger's theory is the need for nurses to appreciate how the individual woman views her own health status.[21] This framework can be extended to include an understanding of why women would choose to give birth at home and not in the hospital. This project sought to identify the reasons why women choose home birth. We anticipated that several themes would emerge during data analysis, which may help health care providers provide culturally competent care to this cultural group.

Sample

A convenience sample of 160 women was selected from 272 respondents who completed an online survey about home birth conducted via a Web site (https://homebirth.study.googlepages.com). Responses were selected if the respondent was a woman who had planned to give birth at home in the United States at least one time. Responses were excluded if the respondent planned only to birth in a birthing center or hospital, was not a woman, or was not a resident of the United States.

Measures and Data Collection Procedures

The original online survey consisted of 30 questions authored by Rixa Freeze. The subset of data used for this study included one open-ended question "Why did you choose homebirth?" and six demographic questions: "State of residence," "Gender," "Age," "Your occupation and education level," "Place and manner of your children's births," and "Involvement with birth." The majority of responses to the question "Why did you choose homebirth?" were brief; all 160 responses were analyzed.

Data Analysis

The de-identified data were collected using Excel, with rows representing the respondents and columns representing the questions. A coding subset was created containing only the respondent's identification number and the responses to the key study question "Why did you choose homebirth?" Content analysis coding proceeded in an orderly fashion from the top of the spreadsheet to the bottom.[22]

Responses were analyzed using the basic and fundamental method of qualitative description as described by Sandelowski.[22] Content analysis was used to relay each respondent's content without extensive interpretation. As each respondent's statement was analyzed, the reasons for choosing home birth were identified, copied, and categorized into themes; the theme descriptions emerged out of the data. A total of 508 reasons were coded into themes. Double-coding of all 160 responses (100%) proceeded as follows: one team member reviewed all of the content, extracted 508 distinct reasons from the 160 responses, and coded the reasons into themes which were identified from the data; then a second team member reviewed the 508 reasons and coded them into themes, using the list of themes that were previously identified. Disagreements were found regarding 37 of the 508 reasons (7.3%), which were then discussed and recoded. A matrix of the themes and the extracted reasons was created and distributed to two other team members, who reviewed the responses within the themes for consistency and accuracy.[23] The matrix was also used to analyze the themes across respondents, combine them into 26 final common themes, and to identify common reasons why US women choose home birth.

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