Paper short abstract:

This paper will present the preliminary findings of research on the motivations of Dutch women to go against medical advice and protocol in choosing high risk homebirth, unassisted birth and cesarean delivery on maternal request.

Paper long abstract:

In 2013, lawsuits against three Dutch midwives spurred the discussion about women's freedom of choice in obstetric care and what to do if a woman chooses to birth 'outside the system'. In the Netherlands, there is a growing group of pregnant women that choose not to adhere to the rules of referral from primary to secondary obstetrical care. On the one hand, there are women with high risk pregnancies who insist on a homebirth. While on the other hand there are women who in the absence of medical indication demand hospital interventions as is the case with caesarean delivery on maternal request. There are also cases of women withdrawing from obstetric care altogether. It is estimated that each year approximately 200 women have planned unassisted homebirths.

To gain this insight into the motives of Dutch women to 'birth outside the system' and the experiences of the health care professionals involved in their care, the WONDERstudy (Why Women Want Other or No Delivery care) was initiated. This paper will present preliminary findings. Important themes arising from analysis of the first round of in-depth interviews are: resistance to the biomedical model of birth, a different risk perception and the impossibility of autonomous choice within the system. The women interviewed frequently perceived midwives not to be the expert on maternity care; for many intuition functioned as authoritative knowledge. Midwives were perceived as 'acting out of fear' and 'disturbing the birth process'. This may have important implications for (the improvement of)midwifery practice.