Women are turning their backs on the health system after being traumatised by childbirth in hospitals, according to a new paper from University of Sydney researchers.
The findings come as the Australian Medical Association updated its position statement on maternal decision-making to greater emphasise a woman's autonomy.
The paper, published in the Journal of Medical Ethics, said doctors and policy makers need to understand why some women are boycotting hospitals and midwives entirely, instead choosing births at home - and sometimes labouring completely unassisted.
"Traumatic experiences during previous childbirth seemed to be a solid motivation in turning mothers to unassisted childbirth," lead author of the Sydney Medical School paper, Dr Jasan Dannaway, wrote.
"The experiences mostly involved situations where there was a lack of consent, active involvement or communication breakdown."
The Australian Medical Association's updated position states a pregnant woman's capacity to make an informed decision "should not be confused with whether or not the doctor or medical practitioner considers her decision to be reasonable, sensible or advisable".
Previously, more emphasis was placed on on how maternal behaviours may damage a foetus, rather than the autonomy of a woman's decision.
Hannah Dahlen, a fellow of the Australian College of Midwives and professor of midwifery, said it was now important for medical professionals to abide by that statement.
She said that women giving birth at home, assisted or not, were not hippie fringe dwellers.
"These women are highly educated and informed, and they are leaving the health system with great sadness because they have no other choice," Professor Dahlen said.
"There aren't enough options within the maternity system that support the way women want to give birth. It's not an individualised system."
Her research team at the University of Western Sydney carried out interviews with hundreds of women to find out why they were choosing home births.
Women had told stories of being forcibly held down and examined by doctors and midwives during previous births, or given caesareans they had not wanted.
"Women are coming out of birth … with post-traumatic stress," Professor Dahlen said.
Women often wanted a midwife to support them during a home birth, she said, but the cost and a lack of insurance covering them meant they were hard to find. Professor Dahlen said women needed to be given more choice within hospital settings.
The president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Michael Permezel, said while having a midwife present at a home birth was ''much safer'' than no health professional, hospitals were the most safe environment.
"There are many things that can happen at home even with a doctor present," Professor Permezel said.
''Our view would be to improve resources in hospitals so fewer women will feel a need to have a home birth. It's wrong to think the presence of a midwife makes home birth as safe as a hospital birth.''
A caesarean that wasn't wanted or necessary
When Erin Quinn was pregnant with her daughter Abigail, now 4, hiring a midwife proved too expensive, so she opted for a natural hospital birth.
"I ended up having a caesarean," Mrs Quinn said. "I agree some caesareans are lifesaving or a woman's choice - but for me it wasn't wanted or necessary."
She had been in labour for 30 hours. "The [doctors] told me every contraction would put my baby's life at risk. I feel like I was intimidated into having a caesarean."
For her second child, Eilidh, she opted for a home birth. She was transferred to hospital when her labour stalled and had another caesarean. But the experience of giving birth at home to her now nine-week-old daughter Samara was "wonderful".
"I wish I had been more aggressive in vocalising what I wanted with my first birth, knowing what I do now," she said.