Why women chose unassisted home birth in Malaysia: A qualitative study

Abstract Background: Reports of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child delivery facilities. We aimed to explore the reasons for women to make such decision. Methods: Twelve mothers participated in-depth interviews. They were identified using snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literature. The interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Results: Women in this study described a range of birthing experiences and personal beliefs to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) a natural process, iii) expressing autonomy and iv) faith, as reasons for choosing unassisted homebirth. Such decision was firm and strong despite the possible risks and complications that can occur during home birthing. Giving birth is perceived to occur naturally regardless of assistance and home birthing provide the preferred environment which health facilities may lack. Women believed that they were much in control of the birth processes apart from fulfilling the spiritual beliefs. Conclusions: Women may choose unassisted home birth to express their personal beliefs and values, at the expense of the health risks. Apart from increasing mothers’ awareness of the possible complications arising from unassisted home births, urgent efforts is needed to providing a better birth experiences in healthcare facilities that resonate with the mothers’ beliefs and values. Keywords: Home birth; free birth; unassisted home birth; Malaysia; healthcare delivery system; qualitative.