References

Birth NI: a survey of women's experience of maternity care in Northern Ireland. 2016. http://www.qub.ac.uk/schools/SchoolofNursingandMidwifery/FileStore/Filetoupload,670193,en.pdf (accessed 29 August 2019)

Behruzi R, Hatem M, Fraser W, Goulet L, Ii M, Misago C Facilitators and barriers in the humanization of childbirth practice in Japan. BMC pregnancy childbirth. 2010; (1)25-25

Birthrights. Dignity in childbirth: the dignity survey 2013: women's and midwives' experiences of UK maternity care. 2013. https://birthrights.org.uk/wp-content/uploads/2013/10/Birthrights-Dignity-Survey-1.pdf (accessed 29 August 2019)

British Institute of Human Rights. Midwifery and human rights: a practitioner's guide. 2016. https://www.bihr.org.uk/midwiferyhumanrights (accessed 29 August 2019)

Bryanton J, Gagnon AJ, Johnston C, Hatem M. Predictors of women's perceptions of the childbirth experience. J Obstet Gynecol Neonatal Nurs. 2008; 37:(1)24-34 https://doi.org/10.1111/j.1552-6909.2007.00203.x

Cresswell JW, Plano Clark VL. Designing and conducting mixed method research, 2nd edn. Thousand Oaks, CA: Sage; 2011

Dahlen HG, Jackson M, Stevens J. Homebirth, freebirth and doulas: casualty and consequences of a broken maternity system. Women Birth. 2011; 24:(1)47-50 https://doi.org/10.1016/j.wombi.2010.11.002

Dannaway J, Dietz HP. Unassisted childbirth: why mothers are leaving the system. J Med Ethics. 2014; 40:(12)817-20 https://doi.org/10.1136/medethics-2012-101150

Department of Health, Social Services and Public Safety. A maternity strategy for Northern Ireland 2012-2018. 2012. https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/maternitystrategy.pdf (accessed 29 August 2019)

Downe S. Beliefs and values moderate evidence in guideline development. BJOG. 2016; 123:(3) https://doi.org/10.1111/1471-0528.13634

Edwards N, Kirkham M. Birthing without a midwife: a literature review. MIDIRS Midwifery Digest. 2013; 23:(1)7-16

Feeley C, Thomson G. Why do some women choose to freebirth in the UK? An interpretative phenomenological study. BMC Pregnancy Childbirth. 2016; 16:(1) https://doi.org/10.1186/s12884-016-0847-6

Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative research. Qual Rep. 2015; 20:(9)1408-16

Guidelines and Audit Implementation Network. Guideline for admission to midwife-led units in Northern Ireland & Northern Ireland: normal labour & birth care pathway. 2016. https://www.rqia.org.uk/RQIA/files/3a/3a7a37bb-d601-4daf-a902-6b60e5fa58c2.pdf (accessed 29 August 2019)

Hollander M, de Miranda E, van Dillen J Women's motivations for choosing a high risk birth setting against medical advice in the Netherlands: a qualitative analysis. BMC Pregnancy Childbirth. 2017; 17:(1) https://doi.org/10.1186/s12884-017-1621-0

Holten L, de Miranda E. Women's motivations for having unassisted childbirth or high-risk homebirth: an exploration of the literature on ‘birthing outside the system’. Midwifery. 2016; 38:55-62 https://doi.org/10.1016/j.midw.2016.03.010

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15:(9)1277-1288 https://doi.org/10.1177/1049732305276687

Jackson M, Dahlen H, Schmied V. Birthing outside the system: perceptions of risk amongst Australian women who have freebirths and high risk homebirths. Midwifery. 2012; 28:(5)561-567 https://doi.org/10.1016/j.midw.2011.11.002

Kruske S, Young K, Jenkinson B, Catchlove A. Maternity care providers' perceptions of women's autonomy and the law. BMC Pregnancy Childbirth. 2013; 13 https://doi.org/10.1186/1471-2393-13-84

Lee S, Ayers S, Holden D. Risk perception and choice of place of birth in women with high risk pregnancies: a qualitative study. Midwifery. 2016; 38:49-54 https://doi.org/10.1016/j.midw.2016.03.008

Mander R, Melender HL. Choice in maternity: rhetoric, reality and resistance. Midwifery. 2009; 25:(6)637-648 https://doi.org/10.1016/j.midw.2007.10.009

Marshall J. Autonomy and the midwife. In: Raynor M, Marshall J, Sullivan A (eds). Edinburgh: Churchill Livingstone; 2005

Royal College of Midwives. State of maternity services report 2016. 2016. https://www.rcm.org.uk/media/2372/state-of-maternity-services-report-2016.pdf (accessed 29 August 2019)

Sandall J, Soltani H, Gates S Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2013; (8) https://doi.org/10.1002/14651858.CD004667.pub3

Tracy SK, Hartz DL, Tracy MB Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. Lancet. 2013; 382:(9906)1723-32 https://doi.org/10.1016/S0140-6736(13)61406-3

Walsh D, Devane D. A metasynthesis of midwife-led care. Qual Health Res. 2012; 22:(7)897-910 https://doi.org/10.1177/1049732312440330

World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. 2016. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en (accessed 29 August 2019)

‘We are just obsessed with risk’: healthcare providers' views on choice of place of birth for women

02 October 2019
20 min read
Volume 27 · Issue 10

Abstract

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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