The role, practice and training of unregulated birth-workers in Australia: a mixed methods study

Introduction: In Australia, the provision of homebirth services by unregulated birthworkers (UBW) (doulas, ex-registered midwives, traditional midwives and lay workers) appears to have increased in recent years. The reasons for this are unclear and no data exists to identify their numbers, training or work practices. Access to a homebirth with a registered midwife via mainstream services is limited and there is growing concern that new legislation aimed at prohibiting UBW practice may result in more women choosing to freebirth (birth at home with no professional support). Aim: To explore the training, practices and role of Australian UBWs who assist women to give birth at home with no registered midwife present. Methods: A mixed methods sequential exploratory design was used and had two phases. In phase 1, 9 participants, (4 UBWs and 5 women) were interviewed in in-depth individual interviews. Findings from Phase 1 informed the development of a National UBW survey in Phase 2. Ethics approval was gained from Western Sydney University Human Research Ethics committee No H10281. Results: UBWs support women to have a normal physiological birth at home when they are unable to access a suitable homebirth from mainstream maternity services. They practice very like a registered midwife would providing antenatal, birth and postnatal care home without a midwife present. UBWs in this study were well educated and the majority held a midwifery (not currently registered or lay), nursing or allied health degree. All had completed further studies either in childbirth and/or complementary therapies to support their role. While UBWs do not call themselves a midwife, women view them as their midwife. Conclusion and implications: When women are unable to access homebirth support from registered maternity health care providers, they will seek support from UBWs. This has implications for the safety of mothers, their infants and UBWs in terms of legal ramifications in light of new Australian legislation which makes a UBW supported birth at home without a midwife illegal in some states. The findings of this study will inform discussions regarding improving mainstream maternity services delivery to ensure it is responsive to woman’s expressed needs and choices