Women’s experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research

Abstract

Background: The purpose of this systematic review (PROSPERO Ref: CRD42017053264) was to describe and interpret the qualitative research on parent's decision-making and informed choice about their pregnancy and birth care. Given the growing evidence on the benefits of different models of maternity care and the prominence of informed choice in health policy, the review aimed to shed light on the research to date and what the findings indicate. Methods: a systematic search and screening of qualitative research concerning parents' decision-making and informed choice experiences about pregnancy and birth care was conducted using PRISMA guidelines. A metasynthesis approach was taken for the extraction and analysis of data and generation of the findings. Studies from 1990s onwards were included to reflect an era of policies promoting choice in maternity care in high-income countries. Results: Thirty-seven original studies were included in the review. A multi-dimensional conceptual framework was developed, consisting of three analytical themes ('Uncertainty', 'Bodily autonomy and integrity' and 'Performing good motherhood') and three inter-linking actions ('Information gathering,' 'Aligning with a birth philosophy,' and 'Balancing aspects of a choice'). Conclusions: Despite the increasing research on decision-making, informed choice is not often a primary research aim, and its development in literature published since the 1990s was difficult to ascertain. The meta-synthesis suggests that decision-making is a dynamic and temporal process, in that it is made within a defined period and invokes both the past, whether this is personal, familial, social or historical, and the future. Our findings also highlighted the importance of embodiment in maternal health experiences, particularly when it comes to decisionmaking about care. Policymakers and practitioners alike should examine critically current choice frameworks to ascertain whether they truly allow for flexibility in decision-making. Health systems should embrace more fluid, personalised models of care to augment service users' decision-making agency.

Barriers to Receiving the Recommended Standard Care During Pregnancy by Illiterate Women in Rural, Northern Tanzania

“…It has been evident for over 40 years that people are rarely rational actors, especially in uncertain situations (60)(61)(62). Decisions arise from a complex and dynamic mix of reason and intuition, informed by one's context, biology, and anticipated outcomes (63,64). As such, a mountain of evidence from public health experts about the bene ts of receiving the recommended standard care during pregnancy and delivery may have no impact on behavior if local perspectives are not considered.…”

I felt so much conflict instead of joy: an analysis of open-ended comments from people in British Columbia who declined care recommendations during pregnancy and childbirth

“…We consider our results in the context of themes and interlinking actions discovered during the meta-synthesis by Yuill et al [ 3 ]. In the meta-synthesis childbearing women wanted to protect their bodily autonomy and integrity through making decisions about their care.…”

“…The published literature about shared decision making (SDM) and informed choice is vast [ 2 ].Yuill et al (2020) performed a meta-synthesis of 37 qualitative studies of women’s experiences of decision making and informed choice during pregnancy and birth [ 3 ]. The included studies described SDM and informed choice as complex and dynamic processes that are characterized by three themes (uncertainty, bodily autonomy & integrity and performing good motherhood) and three interlinking actions (information gathering, balancing choices and aligning with a birth philosophy).…”

“…Yuill et al (2020) describe the disconnect between health care providers who believe they are offering women choices and childbearing women who feel that they have limited control and decision-making power. This has led some authors to describe SDM and informed choice as illusory, idealized or abstract concepts that do not translate well into practice [ 3 ]. For example, providers ought to respect the right of pregnant people to make informed choices and facilitate this process by providing complete, relevant, and objective information in a non-authoritarian, supportive manner.…”

Factors associated with women's satisfaction during labor

“…On other hand, literature, highlights women's belief that hospital was safer than home if complications arise, includes feeling 'protected' by the medical environment, easier access to pain medication, increased monitoring, and belief that it is cleaner than home birth. (Yuill et al, 2020) Ultimately, clean delivery rooms are important indicator of birth satisfaction for all childbearing women. A recently published review summarized the following factors associated with women's satisfaction in childbirth namely accessible, safe, nonthreatening, good physical environment, cleanliness, availability of drugs, supplies and human resources.…”