From hospital to home: Australian midwives' experiences of transitioning into publicly-funded homebirth programs

Background: Over the past two decades, 14 publicly-funded homebirth models have been established in Australian hospitals. Midwives working in these hospitals now have the opportunity to provide homebirth care, despite many having never been exposed to homebirth before. The transition to providing homebirth care can be daunting for midwives who are accustomed to practising in the hospital environment. Aim: To explore midwives' experiences of transitioning from providing hospital to homebirth care in Australian public health systems. Methods: A descriptive, exploratory study was undertaken. Data were collected through in-depth interviews with 13 midwives and midwifery managers who had recent experience transitioning into and working in publicly-funded homebirth programs. Thematic analysis was conducted on interview transcripts. Findings: Six themes were identified. These were: skilling up for homebirth; feeling apprehensive; seeing birth in a newlight; managing a shift in practice; homebirth-the same but different; and the importance of mentoring and support. Discussion: Midwives providing homebirth work differently to those working in hospital settings. More experienced homebirth midwives may provide high quality care in a relaxed environment (compared to a hospital setting). Midwives acceptance of homebirth is influenced by their previous exposure to homebirth. Conclusion: The transition from hospital to homebirth care required midwives to work to the full scope of their practice. When well supported by colleagues and managers, midwives transitioning into publiclyfunded homebirth programs can have a positive experience that allows for a greater understanding of and appreciation for normal birth. (C) 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.