Exploring decision making to create an active offer of planned home birth

Despite planned home birth having the potential to provide a psychologically and physically safe birth environment, home birth is unusual within most highly-resourced countries. Women are not always provided with the opportunity or autonomy to birth at home. Additionally, amongst the small numbers of women who do birth at home, minoritised and marginalised communities are underrepresented.

To explore if an 'active offer' concept may provide a useful approach to offering planned home birth.

This was a sequential multiple methods study, to explore the use of the active offer concept within the context of planned home birth. Initially, non-participant observations of seven birth planning meetings with low risk women and their community midwives were undertaken, followed by individual semi-structured interviews with all participants in order to explore how home birth was integrated within low-risk women's experience of pregnancy. The second phase used focus groups with previous maternity services users and community midwives to develop ideas for the design of a complex Active Offer of Planned Home Birth intervention.

An Active Offer of Planned Home Birth comprising of 'Creating the Conditions' and 'Positive Reinforcement' stages is an intervention that midwives can use to increase the ability of all women to make informed decisions about whether they wish to birth at home. This could serve as a powerful approach in reducing the current inequality in access to home birth.

This is the first research to develop an active offer in the context of planned home birth. The proposed intervention provides a structured way for midwives to offer and support home birth decision making. Further research to test and refine this intervention should now be undertaken.