Decision-making regarding place of birth in high-risk pregnancy: a qualitative study

Abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. This study investigated women's decision making during high risk pregnancies. Half the participants were planning hospital births and half were planning homebirths. Permanent repository linkMethods: A qualitative study using semi-structured interviews set in a hospital maternity department in the United Kingdom. Twenty-six participants with high risk pregnancies, at least 32 weeks pregnant. Results were analysed using systematic thematic analysis.Results: Three themes emerged: perceptions of birth at home and hospital; beliefs about how birth should be; and the decision process. Both groups were concerned about safety but they expressed different concerns. Women drew psychological comfort from their chosen birth location. Women planning homebirths displayed faith in the natural birth process and stressed the quality of the birth experience. Women planning hospital births believed the access to medical care outweighed their misgivings about the physical environment.Discussion: Although women from both groups expressed similar concerns about safety they reached different decisions about how these should be addressed regarding birth location.These differences may be related to beliefs about the birth process. Commitment to their decisions may have helped reduce cognitive stress.

Place and space in relation to childbirth: a critical interpretive synthesis

“…Women´s planned place of birth is influenced by several complex factors, such as cultural and normative expectations and earlier experiences (Coxon, Sandall, & Fulop, 2015). Our study demonstrates that a safe place was a major consideration, regardless of which location birth took place (Burns, 2015;Lee et al, 2016;Parratt & Fahy, 2004). This finding is in line with the recently published review of Downe et al (Downe et al, 2018) that highlighted that women have a strong desire for safe care during childbirth.…”

“… Four major constructs of experience were revealed through analysis and include spatiality, corporeality, temporality and relationality. Lee, Ayers, and Holden ( 2016 ), UK. To examine decisions regarding place of birth among a group of high-risk pregnant women.…”

“…A homely space was characterized by a place where the woman didn´t have to adapt to the environment (Abel & Kearns, 1991 ; Hammond et al, 2014a ; Lock & Gibb, 2003 ; Mondy, Fenwick, Leap, & Foureur, 2016 ). This meant no problem when the birth took place in the women’s own homes where a sense of familiarity, freedom and self-confidence occurred (Abel & Kearns, 1991 ; Bernhard et al, 2014 ; Borrelli, Walsh, & Spiby, 2017 ; Carlsson, 2016 ; Coxon, Sandall, & Fulop, 2014 ; Lee, Ayers, & Holden, 2016 ; Lock & Gibb, 2003 ; Parratt & Fahy, 2004 ). By contrast, entering hospital brought the women into a strange place with design characteristics of an emergency hospital room, uncomfortable and signified by the nature of the bed placed in a central position (Davis & Homer, 2016 ; Davis & Walker, 2010b ; Hammond et al, 2014a ; Lock & Gibb, 2003 ; Mondy et al, 2016 ; Newburn, 2012 ; Townsend, Fenwick, Thomson, & Foureur, 2016 ).…”

“…Moreover, a homely space facilitated the women´s confidence, self-agency, and to take an active role in their care, thus taking more control and enabling them to be a conductor of their own birth experience (Abel & Kearns, 1991 ; Coxon et al, 2014 ; Lee et al, 2016 ; Lock & Gibb, 2003 ; Mondy et al, 2016 ; Newburn, 2012 ). Finally, the design of hospital birth rooms also affected the midwives (Hammond et al, 2014b ; Townsend et al, 2016 ).…”

“…In essence, a homely space contributed to a feeling of being at home, a non-threatening, comfortable relaxing space for the women, which implied a sense of belonging (Lock & Gibb, 2003;Newburn, 2012). Moreover, a homely space facilitated the women´s confidence, self-agency, and to take an active role in their care, thus taking more control and enabling them to be a conductor of their own birth experience (Abel & Kearns, 1991;Coxon et al, 2014;Lee et al, 2016;Lock & Gibb, 2003;Mondy et al, 2016;Newburn, 2012). Finally, the design of hospital birth rooms also affected the midwives (Hammond et al, 2014b;Townsend et al, 2016).…”