The aim of this study was to investigate informed choice in relation to care-giver and location of care, within maternity services in Powys. The study utilized a survey design, eliciting both quantitative and qualitative data from respondents. The aims of the research were to evaluate women's perceptions of the quantity and quality of information received, to highlight examples of good practice and to identify potential areas of concern. The results demonstrated high levels of satisfaction with the amount of information on antenatal and birth care received by women taking part in the study, midwives being identified as playing a key role in informing women in all antenatal and birth settings. Further, the findings suggest that midwives in midwife-led antenatal clinics and midwife/GP maternity units are more successful in imparting information and enabling women to have a sense of participation in the decision-making process. Type of delivery is also identified as a key factor in women's perceptions of participation in informed decision-making with anticipated intervention in birth being a possible indicator of low levels of satisfaction. Thus it may be that organizational, structural or experiential factors affect women's perceptions of having an active role in the decision-making process more than the health care personnel involved. The discussion relates the findings of this study to wider debates on informed choice in maternity services, issues of continuity of carer and effects of cross-boundary services. Areas for further research are identified.

The rate of caesarean births in the UK has risen significantly in the last half a century. This article presents the results of a major national survey of midwives' views on the rising caesarean section rate, including their views on the reasons for this growth and measures to reduce it. Midwives' views on vaginal birth after caesarean (VBAC) are explored, as well as potential conflicts between medical staff.

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