Abstract
Objectivesto investigate women's perceptions of interactions with obstetricians and midwives during high risk pregnancies. The intention was to examine differences and similarities between women planning to give birth at home or in hospital. Designqualitative study using semi-structured interviews. Setting Maternity department in a hospital in South East England. Participantstwenty-six women with high risk pregnancies, at least 32 weeks pregnant. Half were planning hospital births and half homebirths. Measurements and findingssemi-structured interviews to investigate women's perception of communication. Results were analysed using thematic analysis. Four themes emerged: women's experiences of communication about risks in pregnancy; women's perceptions of professionals' beliefs about birth; women's trust in professionals; and women's attitude to professionals' advice. Women spoke more positively about communication with midwives than with obstetricians. Women planning hospital births expressed trust in obstetricians. Women planning homebirths expressed more trust in midwives. Women planning hospital births were less likely to question advice from professionals. Women planning homebirths were more inclined to trust their own instincts when these contradicted professional advice. Key conclusionswomen prefer to communicate with professionals who are respectful of their thoughts and feelings. They may not follow all professional advice. Implications for practiceprofessionals working with women with high risk pregnancies should acknowledge women's concerns and deliver impartial, evidence-based advice.
Highlights
Where to give birth is one of the key decisions women face during pregnancy.Homebirth is widely recognised as a safe option for women with low risk pregnancies (Birthplace in England Collaborative Group 2011) but some women with risks associated with their pregnancies choose to give birth at home, even though this is associated with an increased risk of adverse perinatal outcomes (Hollowell et al 2011)
Reasons women choose for giving birth at home include previous negative experiences in hospital, organisational factors affecting the type of care provided, and perceptions of the care, healthcare professionals and locations available (McCourt et al 2011)
Women with pregnancy-associated risks who plan to give birth at home may face potentially difficult discussions with the professionals involved in their maternity care as their plans are likely to go against the recommended advice
Summary
Where to give birth is one of the key decisions women face during pregnancy.Homebirth is widely recognised as a safe option for women with low risk pregnancies (Birthplace in England Collaborative Group 2011) but some women with risks associated with their pregnancies choose to give birth at home, even though this is associated with an increased risk of adverse perinatal outcomes (Hollowell et al 2011). There is no consensus in the wider literature on the definition of high risk pregnancy (ref removed for blind review), guidelines from the National Institute for Health and Care Excellence, which inform much of healthcare practice in the UK, provide parameters for straightforward pregnancy and labour (NICE 2008; NICE 2014). It is usual practice in the UK for women with straightforward pregnancies to receive only midwifery-led care during pregnancy and childbirth and for women with pregnancy complications to received shared care from obstetricians and midwives (NICE 2008). Pregnant women discuss their choice of place of birth with their midwives and, in cases of pregnancies deemed to be at higher risk, with obstetricians as well
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