Experience of decision-making for home breech birth: An interpretive description

Despite research and recommendations supporting shared decision-making and vaginal birth as a reasonable option for appropriately screened candidates with a term breech pregnancy, cesarean remains the only mode of birth available in most hospitals in the United States. Unable to find care for planned vaginal birth in a hospital setting, some individuals choose to pursue breech birth at home, potentially placing themselves and their infants at increased risk. Through this analysis of qualitative data gathered from a mixed methods study, we explored the experience of decision-making of 25 individuals who left the US hospital system to pursue a home breech birth. Data were gathered through open-ended survey responses (n = 25) and subsequent in-depth, semi-structured interviews (n = 23) and analyzed using an interpretive description approach informed by situational analysis. Five interwoven and dynamic themes were identified in this complex decision-making process: valuing and trusting in normal birth, being "backed into a corner," asserting agency, making an informed choice, and drawing strength from the experience. This study provides a foundation for understanding the experience of decision-making and can inform future research and clinical practice to improve the provision of safe and respectful, person-centered care for breech pregnancy and birth.