The PRIMROSE Project: What is 'physiological birth'? A quantitative approach to the perceptions of the Australian...

The definition of 'physiological birth' by the World Health Organization in 1997 may need to be revisited to better align with current practices in labour and birth in the Australian context, and to better understand the perspectives of women and their care providers. This study explored if obstetric doctors, midwives, doulas, women, and support people (with experience in labour and birth in the last 12 months) recognise physiological birth differently, which interventions they consider congruent with physiological birth, and terms that should be included in a consensus statement of 'physiological birth'.

A self-administered, anonymous, 68-field questionnaire was developed and shared online via social media platforms (Facebook, X, and LinkedIn). The questionnaire included Visual Analogue Scales, multi-choice, Likert scale, and open-text items. Data were collected between August - November 2023.

733 participants interacted with the survey. Medical intervention such as vaginal examination to assess labour progress, was considered congruent with physiological birth, whereas continuous cardiotocography and artificial rupture of membranes were considered to be 'non-physiological'. Doulas associated physiological birth with being 'intervention-free' more strongly than any other group. Obstetrics doctors viewed birth as inherently risky. Respondents indicated that the psychological experience of birth, and terms such as 'spontaneous onset', 'no/minimal intervention' and 'spontaneous delivery/birth' should be included in a consensus statement of 'physiological birth'.

There are multiple understandings of the term 'physiological birth', implying that the term lacks clarity. There are disparities in how care providers and women view intervention in birth; suggesting a consensus statement of 'physiological birth' is appropriate for the Australian context.