Abstract
Home births in high risk pregnancies and unassisted childbirth seem to be increasing in the Netherlands. There is a lack of qualitative data on women's partners' involvement in these choices in the Dutch maternity care system, where integrated midwifery care and home birth are regular options in low risk pregnancies. The majority of available literature focuses on the women's motivations, while the partner's influence on these decisions is much less well understood. We aimed to examine partners' involvement in the decision to birth outside the system, in order to provide medical professionals with insight and recommendations regarding their interactions with these partners in the outpatient clinic. An exploratory qualitative research design with a constructivist approach and a grounded theory method were used. In-depth interviews were performed with twenty-one partners on their involvement in the decision to go against medical advice in choosing a high risk childbirth setting. Open, axial and selective coding of the interview data was done in order to generate themes. Four main themes were found: 1) Talking it through, 2) A shared vision, 3) Defending our views, and 4) Doing it together. One overarching theme emerged that covered all other themes: 'She convinced me'. These data show that the idea to choose a high risk birth setting almost invariably originated with the women, who did most of the research online, filtered the information and convinced the partners of the merit of their plans. Once the partners were convinced, they took a very active and supportive role in defending the plan to the outside world, as well as in preparing for the birth. Maternity care providers can use these findings in cases where there is a discrepancy between the wishes of the woman and the advice of the professional, so they can attempt to involve partners actively during consultations in pregnancy. That will ensure that partners also receive information on all options, risks and benefits of possible birth choices, and that they are truly in support of a final plan.
Highlights
Since approximately the 1960’s, men have been increasingly involved in the process of labor and birth, and are, in most western high income countries, generally expected to be present in the labor room[1]
Maternity care providers can use these findings in cases where there is a discrepancy between the wishes of the woman and the advice of the professional, so they can attempt to involve partners actively during consultations in pregnancy
Many expectant fathers experience a lack of information, which they feel is a barrier to their involvement in the process of decision making concerning childbirth[6,7,8,9,10,11,12,13,14]
Summary
Since approximately the 1960’s, men have been increasingly involved in the process of labor and birth, and are, in most western high income countries, generally expected to be present in the labor room[1]. Many men still feel somewhat disassociated from the process: the majority don’t attend most antenatal appointments and feel that maternity care providers don’t really include them when they counsel their pregnant partners[2,3,4,5]. There are limited data on partner involvement in decisions concerning place of birth and choice of birth attendant, neither when these choices conformed to the local maternity care system, nor when they were against medical advice. In most high income countries, hospital birth has become the norm, and home birth, even in low risk pregnancies, is considered by mainstream maternity care providers as against medical advice[15]. Women with a high risk pregnancy are advised to go to a hospital to give birth under supervision of a gynecologist
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