Abstract
BackgroundThe 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.Methodsa 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 meta-synthesis 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.ResultsThirty-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’).ConclusionsDespite 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 decision-making 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.
Highlights
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
Descriptive findings All of the studies reported in the review were conducted in nine countries, the United Kingdom (UK) (17), the US (7), Canada (5), Australia (4), New Zealand (5), Finland (2), Denmark (1), the Netherlands (1) and Spain (1)
The range of countries included is small because the inclusion criteria was limited to research published in English, and to studies conducted in countries with comparable medical systems to the UK
Summary
As the review encompassed published qualitative data, we employed a meta-synthesis approach to explore the relevant literature, which is anchored around “bringing together and breaking down of findings, examining them, discovering essential features and, in some way, combining phenomena into a transformed whole”.[[21] p314] This new interpretation of, or ‘going beyond’ [22] research is one of the key aspects that sets a metasynthesis apart from a meta-analysis, which aggregates findings to establish ‘truths’. Articles were screened for fit with the inclusion criteria independently by two reviewers (CY and CM), first by title, by abstract and following this by full text. Potentially relevant to a wider discussion, to maintain the focus of the review on decision-making and choice in the context of more standard care pathways. Our search produced a good number of papers about both VBAC and planned caesarean section. We felt that these had more of a specific focus and decision-making contexts that warranted separate reviews in order to explore the themes and unpack the complexities related to each.
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