Factors shaping the sustainability of private homebirth practice: A scoping review of privately practising midwives in high-income settings

BACKGROUND: Privately practising midwives (PPMs) provide midwifery continuity of care, including homebirth services, within increasingly complex regulatory and funding environments that influence the sustainability of their practice. While homebirth continues to attract policy and public scrutiny, the experiences of PPMs have not been comprehensively examined. AIM: To map the existing literature exploring privately practising midwives' experiences of providing homebirth in Australia and comparable high-income countries. DESIGN: A scoping review was conducted in accordance with Arksey and O'Malley's five-stage framework and reported according to the PRISMA-ScR guidelines. Searches of CINAHL, MEDLINE and Embase were undertaken, supplemented by citation searching. Searches were conducted in 2024 and updated in September 2025. Studies published between January 2015 and September 2025 were eligible for inclusion. RESULTS: Seventeen studies from Australia, Aotearoa/New Zealand, the Netherlands, Canada, and the United Kingdom met the inclusion criteria. The majority employed qualitative methodologies. Across jurisdictions, three interconnected concepts were identified: structural marginalisation and professional regulation; economic precarity and workforce sustainability; and professional identity and wellbeing. Midwives described working within systems characterised by indemnity uncertainty, fragmented funding, limited institutional support and heightened scrutiny. These structural conditions influenced professional autonomy, economic viability, and their decisions to remain in private homebirth practice. CONCLUSION: This scoping review synthesises the literature on PPMs' experiences in comparable high-income settings, highlighting the interconnected regulatory, economic, and professional conditions that influence the sustainability of private homebirth practice. The review presents a conceptual model illustrating how these conditions interact within contemporary maternity systems. Strengthening understanding of PPMs' experiences may help inform future research, policy, and workforce discussions regarding the viability of homebirth services.