Every year more and more families are choosing home birth over the hospital. There is a growing movement, in person and online, of parents opting-out of hospital birth, sharing their stories, and encouraging others to do the same. At the same time, the United States is reckoning with its abysmal maternal mortality rates- the majority of which are the result of poor management of dangerous pregnancy complications. How can these two phenomena exist within the same social and cultural conversation? The landscape of home birth in the United States is complex. Data on the safety of home birth is limited, but it appears to be more dangerous than hospital birth. Further complicating the picture is a fractured, private American healthcare system, but families choosing to birth at home are highly motivated to navigate through it. We present multiple theories to explain why so many birthing people are opting for the home, some of which include feminist philosophical arguments, the romanticization of birth, the contemporary all-natural movement, and a strong distrust of our racist medical system. These arguments shed light on the flaws and inadequacies of our maternal healthcare system, and as a medical community we must actively work to alleviate them. We need to nationally and locally address maternal safety and implement practices to dismantle systemic racism within our institutions. While we address maternal mortality, we must also take steps to make home birth an equally safe option for parents who choose it. / Urban Bioethics

Sedan början av 1900-talet har de flesta förlossningar skett på sjukhus och antalet hemförlossningar har minskat drastiskt. Idag är hemförlossningar ytterst ovanligt i Sverige och finns ej som ett vårdval trots att kvinnor har rätt till självbestämmande vad gäller sin graviditet och förlossning.  Syftet var att beskriva kvinnors anledningar till att välja hemförlossning.    En litteraturöversikt med ett systematiskt tillvägagångssätt utfördes som metod. Databassökning skedde i databaserna PubMed, CINAHL samt PsycInfo. Artiklarna kvalitetsgranskades och inkluderade artiklar analyserades med integrerad analys.   Studiens resultat mynnade ut i två huvudkategorier. Den första huvudkategorin var “på kvinnans egna villkor” med subkategorierna “egenmakt och kontroll”, “hemmet som en trygg plats”, “tron på den egna kroppen” och “den fysiologiska födseln” samt “val av närvarande personer”. Den andra huvudkategorin var “att undvika negativa upplevelser” med subkategorierna “tidigare negativa erfarenheter” och “viljan att undvika interventioner”.    Slutsatsen var att det finns olika anledningar till att kvinnor väljer hemförlossning där de främsta är att föda på sina egna villkor och önskan att undvika negativa upplevelser. Kvinnor vill ha inflytande över sin förlossning och ha möjlighet att välja personer som ska närvara och stödja kvinnan. Hon vill föda på en trygg och säker plats, hemmet, där hon har större möjlighet till en normal eller fysiologisk förlossning utan onödiga interventioner. För att främja kvinnors självbestämmande bör alternativ till sjukhusförlossning erbjudas. / Since the beginning of the twentieth century, the majority of births have taken place in hospitals, and the number of home births has decreased substantially. Home birth is utterly rare in Sweden, and it is not a publicly funded option for Swedish women, even though women should have the right to independently make decisions about their pregnancy and labor.   The aim of the study was to describe women’s reasons for choosing home birth.  A literature review with a systematic approach was the performed method. Databases used for this purpose were PubMed, CINAHL and PsycInfo. The articles were quality reviewed and analyzed through integrated analysis.    The findings of the study were presented in two main categories with appurtenant subcategories. The first main category was “the woman’s own terms” with subcategories “empowerment and control”, “the home environment is a safe space”, “belief in the body and the physiologic birth” and “choosing present people”. The second main category was “wanting to avoid negative experiences” with subcategories “previous negative experiences” and “wanting to avoid interventions”.  The conclusion was that there are various reasons why women choose home birth where the main reasons were to give birth on their own terms and a desire to avoid negative experiences. Women want to be able to influence their labor and have the opportunity to choose people who will be present and support the woman. She wants to give birth in a safe and secure place, her home, where she has a better chance for a normal and physiological birth without unnecessary interventions. In order to promote women's self-determination, alternatives to hospital birth should be offered.

This thesis illuminates the experiences, motives, and framing process of a cohort of homebirthing women in Tucson, Arizona who embody the collective action frames of the national homebirth movement. A model of birth frame construction, alignment and adoption is presented that expands current theory on social movement framing processes, cognitive liberation, and life politics in health and self-help related movements. The study explores the evolution of homebirth midwifery nationally and locally. It articulates the main collective action frames that argue against standard maternity care and presents the alternatives proffered by the homebirth movement. It presents micro-level experiences of movement pioneers, macro-articulations of movement leaders, respondent's micro-level birth model framing processes; and how "life politics" have changed birth culture in America. Written materials augmented data obtained from in-depth interviews with (n=38) respondents who homebirthed in Tucson between 1970 and 2000. Content analysis was utilized and grounded theory was employed.

Den normala förlossningen är barnmorskans ansvarsområde. Frisättning av oxytocin är en förutsättning för ett normalt förlossningsförlopp och vårdmiljön har betydelse för detta. Utfallen av hemförlossningar är goda, vid lågriskgraviditet har det inte framkommit några ökade risker vare sig för kvinnor eller barn. I Sverige erbjuds inte hemförlossningar via det generella vårdutbudet. Det finns ett fåtal privata hembarnmorskor samt programmet ”Min Barnmorska” som tillhandahåller assistans vid hemförlossningar. Forskning kring kvinnors erfarenheter av att föda hemma visar på positiva upplevelser. Det finns begränsad kunskap om barnmorskors upplevelser av att bistå hemförlossningar. Syftet med studien var att beskriva barnmorskors upplevelser av att bistå planerade hemförlossningar. Metoden var en allmän litteraturöversikt med kvalitativ ansats och innefattade 15 artiklar. Resultatet sammanställdes i tre kategorier: Att arbeta i enlighet med sin ideologi, Med den födande i fokus och Baksidan med hemförlossning, med tillhörande subkategorier. Barnmorskorna hade en stark tilltro till den naturliga födelseprocessen och önskade arbeta med den födande i fokus. Det var viktigt att kvinnor tilläts göra informerade val gällande beslutet av födelseplats. Barnmorskorna uppskattade arbete i hemmiljö, det möjliggjorde för dem att arbeta utifrån sina sinnen och intuition. Hemmiljön främjande både de födande kvinnorna och barnmorskorna, då de tilläts arbeta i lugn och ro med en födande i taget. I hemmet tilläts förlossningsprocessen ta tid, det var viktigt att inte störa eller utföra onödiga interventioner. Relationen till familjen var en viktig del i att kunna ge adekvat stöd.Barnmorskorna önskade arbeta med kontinuerlig vård för att optimera relationen till familjen och de födandes förlossningsupplevelse. Att arbeta med hemförlossningar resulterade i olika svårigheter, exempelvis fientligt bemötande från annan vårdpersonal, bristfälligt stöd i arbetetoch påverkan på privatlivet. Slutsatsen är att hemförlossningar kan gynna barnmorskor. En arbetsmodell där barnmorskor får tillhandahålla kontinuerlig vård och kombinera arbete i hem- och sjukhusmiljö kan vara alternativ för de barnmorskor som vill arbeta med hemförlossningar. Det krävs mer stöd och resurser men möjliggör att fler barnmorskor får arbeta i enlighet med sin ideologi. / The normal birth is the midwife's area of responsibility. Release of oxytocin is a prerequisite for a normally developed birth process and the care environment has proven to be important for this. Home births have good outcomes, there have been no increased risks for either women or children with low-risk pregnancies. In Sweden, home births are not offered via the general range of care. There are a few private home midwives and the “Min Barnmorska”program that offers assistance during home births. Research on women's experiences of giving birth at home shows positive experiences. There is limited knowledge about midwives' experiences of assisting home births. The aim of the study was to describe midwives' experiences of assisting planned home births. The method was a general literature review with a qualitative approach and included 15 articles. The results were compiled in three categories: Working in accordance with theirideology, With the woman in focus and Disadvantages of home birth, with associated subcategories. The midwives had a strong belief in the natural birth process and wanted to work with the woman in focus. It was important that women were allowed to make informed choices regarding the decision on place of birth. The midwives appreciated working in a home environment, it enabled them to base their work on their senses and intuition. The home environment fostered both the women giving birth and the midwives, as they were allowed to work in peace and quiet with one woman at a time. At home, the delivery process was allowed to take time, it was important not to disturb or perform unnecessary interventions. The relationship with the family was an important part in being able to provide adequate support. The midwives wanted to work with continuous care in order to optimize the relationship with the family and the birth experience of the women giving birth. Working with home births resulted in various difficulties such as hostile treatment from other healthcare staff, inadequate support at work and impact on private life. The conclusion is that home births can benefit midwives. A work model where midwives are allowed to provide continuous care and combine work in a home and hospital environment can be an alternative for those midwives who wish to work with home births. More support and resources are required but it enables more midwives to work in accordance with their ideology.

Bakgrund: Forskning visar att valet av födelseplats har betydelse för kvinnans förlossningsupplevelse. Hemförlossning vid en lågriskgraviditet är ett säkert alternativ till att föda på sjukhus dock är intresset för hemförlossning låg i Sverige. För att kvinnor ska kunna göra ett aktivt val krävs en medvetenhet om de alternativ som finns. Författarna ställer sig frågande till om kvinnor i Sverige vet om att hemförlossning existerar. Syfte: Att belysa kvinnors kunskap och förståelse för hemförlossning i Sverige. Metod: Nitton kvinnor har fått besvara en frågeguide om hemförlossning. Svaren analyserades med en kvalitativ hermeneutisk textanalys. Resultat: Kunskapen om hemförlossning har visat sig variera. I resultatet framkommer 4 huvudteman och 8 underteman. Huvudteman består av ”Kvinnors intresse för hemförlossning varierar”, ”Informationens betydelse för beslutstagande”, ”Hinder för hemförlossning i Sverige” och ”Hemförlossning som en rättighet”. Konklusion:Studien påvisar att det finns en risk att kvinnor inte känner till att hemförlossningen existerar. Det påvisar även större hinder för möjligheten att göra ett aktivt val av födelseplats samt att genomgå en hemförlossning. / Background: Research shows that the choice of place of birth is important for the woman's birth experience. Home birth in a low-risk pregnancy is a safe alternative to giving birth in a hospital, however, interest in home birth is low in Sweden. In order for women to be able to make an active choice, an awareness of the alternatives available is required. The authors ask themselves whether women in Sweden know that home birth exists. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Method: Questionguide analyzed with a qualitative hermeneutic text analysis. Results: Knowledge about home birth has been shown to vary. The result shows 4 main themes and 8 sub-themes. The main themes consist of "Women's interest in home birth varies", "The importance of information for decision-making", "Obstacles to home birth in Sweden" and "Home birth as a right".Conclusion: The study shows that there is risk that women do not know that homebirth exists. It also shows greater obstacles to the possibility of making an active choice of place of birth and undergoing a homebirth.

At the beginning of the 20th century, major technological changes occurred in maternity care in Europe. In connection with the introduction of good hand hygiene, advance medical equipment and use of disinfectants in the hospitals, obstetricians quickly noticed that maternal mortality decreased. This together with the rest of the medical equipment made hospital births safer. The hospitals became more attractive birth places instead of the homes. While the development from homebirth to hospital delivery went fast in Sweden, the midwives who worked in the United Kingdom and the Netherlands kept their role as primary caregiver to pregnant women by opening birth centers (freestanding clinics normally staffed by midwives offering a homely environment) and continued offering assistance with births at home, if that was the wish of the mother. Today, the United Kingdom and the Netherlands are good examples of a maternity care system with free choice where to give birth and with high patient safety. The purpose of this work is to see if Sweden can offer freedom of choice within the maternity care in accordance with Article 8 of the European Convention on Human Rights and applicable legislation. This is done by evaluating as to how maternity care is financed and the midwives’ role in the countries like the Netherlands and the United Kingdom and compared with Sweden. Today, maternity care in Sweden is severely criticized, not least by healthcare staff due to poor working environment. Pregnant women feel an uncertainty before childbirth, which has led to the government and Swedish municipalities and county councils to decide to make a major effort to improve maternity care and women's health. Within the framework of the development of the healthcare, this work suggests that a review of the freedom of choice in childbirth care would be a natural part to include in the reform.

This diploma thesis deals with home births and how they were referred to in the media regarding the medial cause with a midwife Ivana Königsmarková. The goal of this work is to describe approaches that can be traced on this cause, what is the gender dimension of these approaches like and how does the aspect of power manifest itself on them. To achieve that I've chosen a method of discourse analysis which is the best one to point out the relation between language, power and ideology. Analysed material is represented by the articles from Czech media that are associated with the given cause and on basis of which the most frequently occurring topics can be traced along with their tendencies throughout time. Last but not least I'm closely analysing two chosen articles which represent two dominant ways of thinking - the medical approach of labour and natural or alternative approach.

The childbirth in the medical discourse is still viewed as a proces of high risk. The birth at home is then in such a discourse considered to be hazardous practice which can threaten the life of the unborn child. This paper tries to contribute to the discussions about the freedom of choice of the place of birth. The birth is then viewed from the perspective of gender as a constructed phenomenon culturaly and socialy biased. The main focus is on the research of the experience of women who gave birth at home. Their experience is to be considered as constructed as well, therefore I investigate the leverages that influence their interpretation of the birth experience. I am also interested in researching how their experience influenced their futher life and what meaning they asign to it in the context of their life experience as such. Further interest of this paper is to research the knowledge that the women, who gave birth at home, used during the proces of childbirth. The main focus is to elicit the auhoritative knowledge based on which they make decisions and how this knowledge is constituted.

This study ethnographically explores the experiences of 30 American Mormon women who chose to give birth at home, a practice which differs from the culturally expected birth practice supported by most media birth scenes. The dominant birth practice among American Mormon women aligns with the biomedical birth system nearly universally practiced in the United States. Recent research indicates that the biomedical model is supported by most media portrayals of birth (Elson 1997b). Mormon women who had given birth at home with a midwife were located and invited to participate. A semi-structured interview guide was used to frame the research process. Verbatim transcriptions of the interviews provided the raw data for coding and analysis.

Homebirth as Actor-Network: Multiple realities The topic of this medical anthropology thesis is a description of homebirth seen through the eyes of Actor-Network Theory. The focus of this work is thus not on the professional concept of homebirth as a biological process or soon-to-be-mothers experience and take on homebirth. Focus is on homebirth in itself, how it is enacted via interactions of actors in network. After the presentation of two points of view on medicine (disease and illness), an introduction into the basic principles and innovations of ANT (including anthropology of symmetry), into the works of people, who build their ideas on it (Mol - multiplicity, De Laet - fluidity, Law) and the presentation of the current birthing situation in the Czech Republic, the thesis shifts its focus to the description of the whole actor-network, which enacts homebirth via interaction between the actors in practice. These practices are abstracted from the interviews with mothers, a dula and a paediatrician. The description includes people and objects, because according to ANT, they have the same amount of social agency. Homebirth is then enacted by the objects needed for homebirth - tools to make birth easier and to support its process, by people who partake, venues it takes place in and the birthing positions it...