Parental decision making regarding level of newborn screening participation in the homebirth setting.

Newborn screening (NBS) is a public health initiative (PHI) that identifies newborns with critical health conditions or deafness, allowing for intervention or life-saving treatments. Information regarding NBS education following homebirths is limited. We sought to understand homebirth parents' NBS experiences. Interview participants were recruited from Facebook through a screening questionnaire. An interpretivist paradigm was employed through narrative analysis, deriving themes from the life-experiences of homebirth clients about provision/abnegation from NBS. Five domains were identified after reading transcripts and appreciating common interviewee experiences. Subsequently, interviews were inductively double coded to highlight subthemes classified into each narrative domain. The narrative domains are: Birth Setting, Birth Plan, NBS, Misconceptions, and Education. Birth Setting highlights themes impacting both hospital and homebirth settings. Decisions about subsequent birth setting were influenced frequently by themes classified within narrative domains of Birth Plan and NBS. Finally, client stories highlight a reported desire for greater Education. This need is also apparent due to the presence of Misconceptions regarding NBS. All five narrative domains are interdependent with aspects of each impacting client perceptions and actions within other domains. Misconceptions breed mistrust; fostering greater psychological safety through comprehensive consent discussions- exploring client goals and understanding -may increase trust in PHIs. Consent should focus on the purpose and abilities of NBS; thus, reducing risk perception and enhancing understanding of its benefits in both homebirth and hospital settings. Paired written and oral communication, multidisciplinary care leveraging genetic counselors, and focused continuing medical education for midwives and prenatal providers may further improve NBS.