Community Perspectives on Home Birth in Saudi Arabia

Objective: To assess the perspectives of the community towards the practice of homebirth in Saudi Arabia and determine the challenges inherent in rolling out a policy and practice of homebirth in Saudi Arabia. Design and Setting: Cross-sectional design using a 14-item online survey instrument. Participants: 5930 respondents to the online survey gave their views on homebirth in Saudi Arabia during the COVID-19 pandemic. Findings: 35.1% of respondents were interested in the potential for a homebirth, with the COVID-19 pandemic situation cited as the reason for 49.8% of those responses, followed by 19.5% that hoped to avoid unnecessary medical interventions. 18.9% of respondents viewed the home as a more comfortable environment in which to give birth, and a desire for psychological support from family at home (14.9%). Privacy giving birth at home and financial concerns (costs of childbirth) were also cited as reasons for their preference at 7.9% and 5.6% respectively. 46.6% of respondents were not interested in the potential for a homebirth, 98.8% of which attributed this to the belief in the safety of hospitals because of the availability of a full medical team and supporting facilities. 18.3% were undecided and gave reasons such as COVID-19 risk of infection and restrictions at hospitals surrounding birth, the desire to avoid unnecessary medical interventions at hospital and the interest in the concept of homebirth coupled with anxiety around safety or lack of clarity on the degree of cooperation between the care they would receive at home and the hospital in case of emergencies. Key Conclusions and Implications for Practice: There is significant interest in the concept of homebirth in the Kingdom of Saudi Arabia, currently due to the COVID-19 pandemic and its unknown parameters, but also stemming from a desire of women to have a more positive birth experience and avoid unnecessary medical interventions. Women are concerned that there is a lack of clarity surrounding the level of cooperation if they give birth at home with the hospital in case of any emergency. This indicates a clear need for a fully developed and implemented homebirth policy, fully integrated with existing maternity care services in Saudi Arabia.