Facilitating women's choice in maternity care

International journal of childbirth, 2012

To explore Greek Cypriot women's perceptions of their right to choose the place of childbirth. DESIGN: This study is qualitative and is based on Husserl's phenomenological approach. The field work extended over a 6-month period in 2010-2011. In all cities of the Republic of Cyprus. Purposive sample of 55 women within 1 year after birth. Forty-eight women were recruited for semistructured interviews and six of them took place in first focus group. The second group consisted of seven women that did not participate in interviews. Women's perceptions were categorized into four themes: (a) informed choice for birth place, (b) trusting relationship with health professionals, (c) medicalization of childbirth, and (d) safety of the mother and baby. There is no equity and accessibility in Cyprus maternity care system because it does not provide correct information and accessibility to all birthplace choices. This study demonstrated the need to explore women's views before formulating policy for maternity care. These views will be helpful for the creation of an innovative evidence-based maternity care policy, taking into account women's needs, and will be helpful to raise awareness among health professionals for maternity care improvement. Ensuring the right for birthplace choices is a social and political necessity that enhances the existing health care systems and health professionals to provide quality and holistic maternity care. Conducting more studies on maternity care in Cyprus will reinforce the aim for improving the health of the women, neonates, and society.

Midwifery, 2012

Objective: to provide a critical synthesis of published research concerning women's experiences in choosing where to give birth. Method: an integrative literature review was conducted using three databases (MEDLINE, CINAHL and Ovid) for 1997-2009. Inclusion criteria were: (1) publication in the English language; (2) research article; (3) focus on women's perceptions for their birthplace choices; and (4) data collected during pregnancy, at birth and post partum. Findings: twenty-one research-based papers met the inclusion criteria, and these used a range of approaches and methods. Four themes were derived from the data: choice of birthplace and medicalisation of childbirth; the midwifery model of care and the rhetoric of birthplace choices; perceptions of safety shaped women's preferences; and choice is related to women's autonomy. Conclusion: there is considerable evidence that women worldwide wish to be able to exercise their rights and make informed choices about where to give birth. The medical model remains a strong and powerful influence on women's decisions in many countries. The midwifery model offers birthplace choices to women, while policies and culture in some countries affect midwifery practise. Perceptions of safety shaped women's preferences, and women's autonomy facilitated birthplace choices. Implications for practise: these findings can be seen as a challenge for health professionals and policy makers to improve perinatal care based on women's needs. Local research is advisable due to cultural and health system differences.

2011

Background: Medicalization has led to the standardization of American maternity care and limited the choices of pregnant women by restricting their access to alternative types of care. While there is evidence that women are dissatisfied with this trend, very little is known about how pregnant women make decisions in the current maternity care environment. Objective: To describe the conceptual frameworks women use in making maternity care and birth decisions by exploring the context in which these choices are made. Methods: In-depth, semi-structured interviews were conducted with 22 women between March and December of 2010. Results: Three major themes emerged from the data. The first theme is that women take an active role in their own maternity care through the formation of goals, some of which were better served by the maternity care system than others. Second, women articulated underlying birth philosophies and discussed the philosophies of their caregivers. Dissonance between a patient's birth philosophy and that of her provider led to tension and mistrust. The final theme is a discussion of choice and barriers in maternity care. The lack of choice that many women experienced led to difficulties in receiving the type and amount of maternity care that was most appropriate for them and resulted in frustration and dissatisfaction with the provision of their care. Conclusions: These findings call for expanded access to nonstandard maternity care, the removal of barriers to alternative care, and more vigilant observation of fully informed consent. Quality maternity care must provide support for meaningful choices whether or not those decisions reflect current maternity care norms. Public Health Significance: Over four million women become pregnant and give

PLOS ONE, 2020

Home births in high risk pregnancies and unassisted childbirth seem to be increasing in the Netherlands. There is a lack of qualitative data on women's partners' involvement in these choices in the Dutch maternity care system, where integrated midwifery care and home birth are regular options in low risk pregnancies. The majority of available literature focuses on the women's motivations, while the partner's influence on these decisions is much less well understood. We aimed to examine partners' involvement in the decision to birth outside the system, in order to provide medical professionals with insight and recommendations regarding their interactions with these partners in the outpatient clinic. An exploratory qualitative research design with a constructivist approach and a grounded theory method were used. In-depth interviews were performed with twenty-one partners on their involvement in the decision to go against medical advice in choosing a high risk childbirth setting. Open, axial and selective coding of the interview data was done in order to generate themes. Four main themes were found: 1) Talking it through, 2) A shared vision, 3) Defending our views, and 4) Doing it together. One overarching theme emerged that covered all other themes: 'She convinced me'. These data show that the idea to choose a high risk birth setting almost invariably originated with the women, who did most of the research online, filtered the information and convinced the partners of the merit of their plans. Once the partners were convinced, they took a very active and supportive role in defending the plan to the outside world, as well as in preparing for the birth. Maternity care providers can use these findings in cases where there is a discrepancy between the wishes of the woman and the advice of the professional, so they can attempt to involve partners actively during consultations in pregnancy. That will ensure that partners also receive information on all options, risks and benefits of possible birth choices, and that they are truly in support of a final plan.

Health, Risk & Society, 2014

Over the past 50 years, two things have changed for women giving birth in highincome nations; birth has become much safer, and now takes place in hospital rather than at home. The extent to which these phenomena are related is a source of ongoing debate, but concern about high intervention rates in hospitals, and financial pressures on health care systems, have led governments, clinicians and groups representing women to support a return to birth in 'alternative' settings such as midwife-led birth centres or at home, particularly for well women with healthy pregnancies. Despite this, most women still plan to give birth in high-technology hospital labour wards. In this article, we draw on a longitudinal narrative study of pregnant women at three maternity services in England between October 2009 and November 2010. Our findings indicate that for many women, hospital birth with access to medical care remained the default option. When women planned hospital birth, they often conceptualised birth as medically risky, and did not raise concerns about overuse of birth interventions; instead, these were considered an essential form of rescue from the uncertainties of birth. Those who planned birth in alternative settings also emphasised their intention, and obligation, to seek medical care if necessary. Using sociocultural theories of risk to focus our analysis, we argue that planning place of birth is mediated by cultural and historical associations between birth and safety, and further influenced by prominent contemporary narratives of risk, blame and the responsibility. We conclude that even with high-level support for 'alternative' settings for birth, these discourses constrain women's decisions, and effectively limit opportunities for planning birth in settings other than hospital labour wards. Our contention is that a combination of cultural and social factors helps explain the continued high uptake of hospital obstetric unit birth, and that for this to change, birth in alternative settings would need to be positioned as a culturally normative and acceptable practice.

Women's Health - Open Journal, 2017

Aim: To explore Dutch pregnant women's experiences of shared-decision making about place of birth to better understand this process for midwifery care purposes. Design: Qualitative exploratory study with a constant comparison/grounded theory design. Methods: We performed semi-structured interviews, including two focus groups and eight individual interviews among 16 primarous and multiparous women with uncomplicated pregnancies. Consent was obtained and interviews were audiotaped and fully transcribed. The interviews were analyzed utilizing a cyclical process of coding and categorizing, following which the themes were structured based on the three-step shared-decision making model of Elwyn. 1 Results: We identified the three themes according to Elwyn's model: Choice talk, Option talk and Decision talk. We expanded the model with one additional theme: Decision ownership. The four themes explained women's decision making process about place of birth. Women perceived shared-decision making about place of birth as a decision to be taken with their partner instead of with the midwife. Women and their partners regarded the decision about place of birth as a choice to be made as a couple and expecting parents; not as a decision in which the midwife needs to be actively involved. Women and their partners considered their options and developed a strong preference about where to give birth; even before the initial contact with the midwife was made. Involvement of the midwife occurred during the later stages of the decision-making process, where the women sought acknowledgement of their choice which was already made. Conclusion: Women considered their partners as the most and actively involved in the shareddecision making process regarding the place of birth. The women's decision-making process about the place of birth did not fully occur during the antenatal care period. The midwife should ideally be involved before or during the early stages of pregnancy to facilitate the process.

2017

Aim: To explore Dutch pregnant women's experiences of shared-decision making about place of birth to better understand this process for midwifery care purposes. Design: Qualitative exploratory study with a constant comparison/grounded theory design. Methods: We performed semi-structured interviews, including two focus groups and eight individual interviews among 16 primarous and multiparous women with uncomplicated pregnancies. Consent was obtained and interviews were audiotaped and fully transcribed. The interviews were analyzed utilizing a cyclical process of coding and categorizing, following which the themes were structured based on the three-step shared-decision making model of Elwyn. Results: We identified the three themes according to Elwyn's model: Choice talk, Option talk and Decision talk. We expanded the model with one additional theme: Decision ownership. The four themes explained women's decision making process about place of birth. Women perceived shared-decision making about place of birth as a decision to be taken with their partner instead of with the midwife. Women and their partners regarded the decision about place of birth as a choice to be made as a couple and expecting parents; not as a decision in which the midwife needs to be actively involved. Women and their partners considered their options and developed a strong preference about where to give birth; even before the initial contact with the midwife was made. Involvement of the midwife occurred during the later stages of the decision-making process, where the women sought acknowledgement of their choice which was already made. Conclusion: Women considered their partners as the most and actively involved in the shared-decision making process regarding the place of birth. The women's decision-making process about the place of birth did not fully occur during the antenatal care period. The midwife should ideally be involved before or during the early stages of pregnancy to facilitate the process.

Qualitative Health Research, 2012

Context: Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. Objective: To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings.

The virtual mentor : VM, 2004

Choice" is a central concept in the struggle for reproductive freedom around the world. Yet one of the most damaging consequences of our bruising abortion debates is the gutting of choice itself. In US political discourse, "choice" has come to be identified almost exclusively with the right to choose an abortion, and "reproductive rights" has been conflated with this narrow, legalistic notion of choice. But for many women, reproduction includes both the prevention of unwanted pregnancy and the process of carrying a pregnancy, progressing through labor, and giving birth to a child. Wherever a woman finds herself on that spectrum, her experience of reproductive choice is not just a yes-or-no decision protected in law; rather, the experience of reproductive freedom is profoundly influenced by her interactions with the health system. Thus access to health care must be a core element of choice. Moreover, access ultimately means more than getting in the door. In a system that respects, upholds, and values reproductive freedom, access implies entrée to health care practices that acknowledge the complexity of the reproductive experience for women-its social, psychological, and political dimensions-and that honor the different choices women make throughout that experience. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.

Midwifery, 2002

Objective: to describe the extent to which women using maternity services perceive that they have exercised informed choice.