‘We are just obsessed with risk’: healthcare providers' views on choice of place of birth for women
Women make choices throughout pregnancy and childbirth and interactions with healthcare providers are integral to the journey. Healthcare providers have the potential to advise, influence and support women in their choices as to where to give birth. The aim of this study was to examine Northern Ireland healthcare providers' attitudes and experiences of women choosing place of birth, independent of risk profile. A qualitative study design was used to undertake key informant interviews with healthcare providers who were involved in caring for women antenatally, intrapartum and postnatally. Seven midwives and five obstetricians were interviewed. These interviews were transcribed, coded and presented in themes. Emerging themes included: informed decision-making among pregnant women; understanding and judgement of risk; autonomy and choice; culture of control and fear; and human rights. Interviewees highlighted barriers to women being able to access their chosen place of birth because of legal concerns, cultural perception of birth, and lack of senior managerial support for those providing clinical care to women who are considered at risk of complications during pregnancy or birth. Proposed solutions include developing a human rights-based approach which is about health and not isolated pathologies and focuses on empowering women, and not merely avoiding maternal morbidity or mortality.
It is a woman's right to make an informed choice regarding where she wishes to give birth (Birthrights, 2013). Globally, it is recommended that women's individual health needs should be taken into consideration when designing and implementing maternity services and that women should be offered more choice (World Health Organization [WHO], 2016). Choices regarding place of birth can be complex, important and difficult life decisions (Edwards, 2008). Women should be given the opportunity to have a birth experience that is positive and choice regarding place of birth is a crucial factor in determining birth experience (Bryanton et al, 2008).
The WHO guideline states that most women want a physiological labour and birth, and to have a sense of personal achievement and control through involvement in decision-making, even when medical interventions are needed or wanted (WHO, 2018). It also highlights how woman-centred care can optimise the quality of labour and childbirth care through a holistic, human rights-based approach. Midwifery-led care (MLC) models that encourage continuity-of-care, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum and postnatal continuum, are recommended for all pregnant women (WHO, 2018). MLC models of care aim to offer increased control and choice for women and their families during and after pregnancy (Walsh and Devane, 2012).
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