Choice In Maternity Care Research Articles

Touch in Irish performance art: Haptic encounters in Becoming Beloved (1995) and The Touching Contract (2016)

Over the last 50 years, Irish feminists have campaigned for women’s sexual health and reproductive rights, including access to contraception, legal abortion and choice in maternity care and childbirth. Recent cases like Ms. Y (2014), P. P. v. HSE (2014) and Ms. B (2016) invite a close scrutiny of the power dynamics relating to women’s reproductive bodies in Ireland. This article examines Becoming Beloved (1995) and The Touching Contract (2016), two performance-based artworks located in Dublin maternity hospitals. Both artworks centred the body as a site of production to interrogate these power dynamics while engaging with specifics of each location. This article charts the management of childbearing bodies in Ireland, looking specifically at issues concerning reproductive and sexual health, information and consent. It details how Irish performance art has responded to the political, social and cultural climate of restrictions on women’s bodies. Becoming Beloved and The Touching Contract both employed haptic encounters, multisensory perceptions composed of tactile, kinaesthetic and proprioceptive sensations that extended beyond a visual aesthetic. These haptic encounters contributed to a dimension of viewer engagement, integral in performance art to activating meaning. This article examines how these two artworks utilized haptic encounters to produce a situated, corporeal knowledge that critiqued the authority wielded over reproductive bodies by political, religious and medical establishments in Ireland.

Women\u2019s experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research

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.

Comparison of midwife-led care and obstetrician-led care on maternal and neonatal outcomes in Singapore: A retrospective cohort study

Objectivesto examine the maternal and neonatal outcomes of low-risk women receiving midwife-led care and obstetrician-led care. Design, setting,&participantsa retrospective cohort study design was used. Data were collected from a large tertiary maternity hospital in Singapore. This involved a medical record review of 368 women who had singleton, normal to low-risk, term pregnancy, and received midwife-led care and obstetrician-led care between 2013 to 2014. Measurementsa data extraction tool was used to solicit information on the outcome measures, including duration of labour, mode of delivery, episiotomy, and 5-minutes Apgar score (<7). Descriptive statistics were used to summarise the women's ‘characteristics. χ2 and independent sample t-test were used to assess the differences in demographics and birth outcomes. Multiple linear and logistic regressions were used to examine the difference between the two comparison groups after adjusted for potential confounders. Findingsstatistically significant differences (p<0.05) between the midwife-led care group and the obstetrician-led care group in terms of the total duration of labour and total antenatal visits were found. No statistically significant differences were observed for mode of delivery, episiotomy, intrapartum pain management, labour augmentation, labour induction, postpartum haemorrhage, perineal trauma, birth status, 5-minutes Apgar score (<7), low birth weight (<2500g), and neonatal admission to intensive care units between the midwife-led care group and the obstetrician-led care group. Key conclusionswhile interventions such as episiotomies and labour augmentation were more common in the midwife-led care group, no significant differences were found for most of the outcome measures between the two maternity groups except for total antenatal visits and duration of labour. Findings suggest that midwife-led care is as safe and effective as obstetrician-led care in achieving optimal birth outcomes, with no higher risk of adversities for low-risk women. Additional studies are necessary to continuously evaluate midwife-led care and to promote normal birth and reduce excessive use of obstetric procedures. Implications for practicethe provision of midwife-led care should continue to be extended as an additional choice in maternity care for women with low-risk pregnancies. Professional staff development with continuous education is needed to clear misconceptions about midwife-led care and to promote awareness in current practice guidelines. Prospective evaluation of midwife-led care will be beneficial in informing policies and practise guidelines.

The culture of midwifery and autonomy

British Journal of MidwiferyVol. 22, No. 9 Your VoiceThe culture of midwifery and autonomyJenny SmithJenny SmithSearch for more papers by this authorJenny SmithPublished Online:9 Sep 2014https://doi.org/10.12968/bjom.2014.22.9.675AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferencesAnderson K, Jack DC (1991) Learning to listen: Interview techniques and analysis. In: Gluck SBPatai D (Eds) Women's words: The feminist practice of oral history. Routledge, New York Google ScholarBarry (2006) Humanity and justice in global perspective. In: Goodin REPettit PPogge TW (Eds) Contemporary political philosophy : An anthology. Blackwell, Oxford Google ScholarBattersby S (2014) The role of the midwife in breastfeeding: Dichotomies and dissonance. British Journal of Midwifery 22(8): 551–6 Link, Google ScholarDeci EL, Ryan RM (2000) The ‘what’ and ‘why’ of goal pursuits: Human needs and the selfdetermination of behaviour. Psychological Inquiry 11(4): 227–268. Crossref, Google Scholarde Jonge A, van der Goes BY, Ravelli AC, Amelink-Verburg MP, Mol BW, Nijhuis JG, Bennebroek Gravenhorst J, Buitendijk SE (2009) Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG ı(9): 1177–84. doi: 10.1111/j.1471-0528.2009.02175.x Crossref, Google ScholarDepartment of Health (1993) Changing Childbirth: Report of the Expert Maternity Group P. The Stationery Office, London Google ScholarEdwards N (2004) Why can't women just say no? And does it really matter? Kirkham M (Ed) Informed Choice in Maternity Care. Palgrave MacMillan, London Google ScholarEgan G (1990) The skilled helper: A systematic approach to effective helping. Pacific Grove, California Google ScholarGreen JM, Coupland VA, Kitzinger JV (1990) Expectations, experiences and psychological outcomes of childbirth: A prospective study of 825 women. Birth 17(1): 15–12 Crossref, Google ScholarGuilliland K, Pairman S (1995) The midwifery partnership : A model for practice. Victoria University of Wellington, Wellington Google ScholarHodnett ED, Downe S, Walsh D (2012) Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev 8: CD000012. doi: 10.1002/14651858.CD000012.pub4 Google ScholarJomeen J (2006) Choice in childbirth : psychology, experiences and understanding. PhD thesis, University of Leeds. Google ScholarJomeen J (2010) Choice, control and contemporary childbirth : understanding through women's stories. Radcliffe, Oxford Google ScholarKirkham M (1999) The culture of midwifery in the National Health Service in England. J Adv Nurs 30(3): 732–9 Crossref, Google ScholarKirkham M (2004) Informed Choice in Maternity Care. Palgrave Macmillan, Basingstoke Google ScholarLevy V (1999) Maintaining equilibrium: A grounded theory study of the processes involved when women make informed choices during pregnancy. Midwifery 15(2): 109–19 Crossref, Google ScholarMande R (1993) Who chooses the choices? Modern Midwife 5(1): 23–5 Google ScholarMander R (2001) Supportive care and midwifery. Blackwell Science, Oxford Crossref, Google ScholarNursing and Midwifery Council (2012) Midwives rules and standards. Nursing Midwifery Council, London Google ScholarOakley A (2005) The Ann Oakley Reader : Gender, Women, and Social Science. Policy, Bristol Crossref, Google ScholarPublic Health England (2014) Public health contribution of nurses and midwives: guidance. PHE, London Google ScholarRoyal College of Midwives (2008) Position statement: Women centred care. RCM, London Google ScholarRyff CD (1989) Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology 57(6): 1069–81 Crossref, Google ScholarSilverton L (1993) The Art and Science of Midwifery. Prentice Hall, London Google ScholarSteele R (1995) Midwifery Care in the First Stage of Labour. Levy AJRoch S (Eds) Aspects of Midwifery Practice: a research based approach. Macmillan, Basingstoke Crossref, Google ScholarSymonds A, Hunt SC (1996) The Midwife And Society: Perspectives, Policies And Practice. Macmillan Press, London Crossref, Google ScholarSymon A (2006) Risk and Choice in Maternity Care : An International Perspective. Churchill Livingstone, Edinburgh Google Scholar FiguresReferencesRelatedDetails 2 September 2014Volume 22Issue 9ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 9 September 2014 Published in print 2 September 2014 Information© MA Healthcare LimitedPDF download

Facilitating Women’s Choice in Maternity Care

Maternity careproviders often have strong views concerning a woman's choice of where to give birth.These views may be based on the ethical principle of autonomy, or on the principle of beneficence. The authors propose that an approach utilizing shared decision making allows careproviders and women to move beyond disagreements regarding which evidence on risk should "counts' instead adopting a process of increased knowledge and support for women and their partner while they make choices regarding place of birth.

The paradox of choice in maternity care

Current policy advocates choice and control for women within maternity care and promotes women as active childbirth consumers and decision-makers (DH, 2007; DH, 2004) This model equates choice to increased quality of experience and improved emotional outcomes, in the recognition that pregnancy and childbirth are both a physical and psychological experiences. This is a response to the critique of the traditional biomedical model of pregnancy, which prioritises the physical aspects of pregnancy and advocates monitoring and surveillance to ensure fetal well-being. However, what informed choice means and whether it is desirable or possible remains central to debates within maternity care... This journal article discusses the paradox of choice in maternity care.

Choice in maternity care: associations with unit supply, geographic accessibility and user characteristics

BackgroundDespite national policies to promote user choice for health services in many European countries, current trends in maternity unit closures create a context in which user choice may be reduced, not expanded. Little attention has been paid to the potential impact of closures on pregnant women’s choice of maternity unit. We study here how pregnant women’s choices interact with the distance they must travel to give birth, individual socioeconomic characteristics and the supply of maternity units in France in 2003.ResultsOverall, about one-third of women chose their maternity units based on proximity. This proportion increased steeply as supply was constrained. Greater distances between the first and second closest maternity unit were strongly associated with increasing preferences for proximity; when these distances were ≥ 30 km, over 85% of women selected the closest unit (revealed preference) and over 70% reported that proximity was the reason for their choice (expressed preference). Women living at a short distance to the closest maternity unit appeared to be more sensitive to increases in distance between their first and second closest available maternity units. The preference for proximity, expressed and revealed, was related to demographic and social characteristics: women from households in the manual worker class chose a maternity unit based on its proximity more often and also went to the nearest unit when compared with women from professional and managerial households. These sociodemographic associations held true after adjusting for supply factors, maternal age and socioeconomic status.ConclusionsChoice seems to be arbitrated in both absolute and relative terms. Taking changes in supply into consideration and how these affect choice is an important element for assessing the real impact of maternity unit closures on pregnant women’s experiences. An indicator measuring the proportion of women for whom the distance between the first and second maternity unit is greater than 30 km can provide a simple measure of choice to complement indicators of geographic accessibility in evaluations of the impact of maternity unit closures.

The impact of choice of maternity care on psychological health outcomes for women during pregnancy and the postnatal period

Psychological factors are acknowledged to impact on pregnancy, birth, neonatal outcomes and maternal mental health. The importance of psychological well-being is now recognized within maternity care and UK maternity policy advocates choice and control, equating this to increased quality of experience and improved psychological outcomes. There remains, however, lack of substantive and consistent evidence with regard to the psychological benefits of choice in maternity care. The aim of this study is to investigate the impact of choice of maternity care on psychological health outcomes. 165 antenatal women were recruited and sampled according to their choices for care. Women were assessed utilizing the Hospital Anxiety and Depression Scale (HADS), Edinburgh Postnatal Depression Scale (EPDS), Cambridge Worry Scale (CWS), Multidimensional Health Locus of Control (MHLC), SF-36, Pittsburgh Sleep Quality Index (PSQI) and Culture Free Self-esteem Inventory (CFSEI) at 12 and 32 weeks pregnant and 14 days and 6 months postnatal. No significant differences between groups were revealed on any of the scales or subscales measured. Significant and corresponding differences were identified within groups over time for CWS socio-medical worries, MHLC 'powerful others', SF-36 bodily pain, vitality personal health and change in health, PSQI global sleep. An interaction effect for CFSEI general and social self-esteem was revealed between birth centre and midwifery-led care/main unit women at 14 days postnatal. These results demonstrate that pregnancy represents a psychological challenge regardless of care type chosen and choice of no one care option confers greater psychological benefit across the maternity experience as a whole. It is possible, however, that differences in experience or environment at critical times can affect psychological status.

Professional fear: a barrier to consent

Consent issues seem to be dominating our postbag at present, which is ironic when you consider all the emphasis on choice in maternity care, now officially carrying the seal of approval from Whitehall. Whenever we see an increase in any type of complaint, the Chair (Beverley Beech) and I get together and try to identify reasons and underlying factors. We go through the files and mull over the telephone calls.

Women's perceptions of informed choice in maternity care

Objective: to describe the extent to which women using maternity services perceive that they have exercised informed choice. Setting: twelve maternity units in Wales. Design: postal survey of women using maternity services, covering women's views of the extent to which they exercised informed choice overall, and at eight decision points during their care. Participants: 1386 women at approximately 28 weeks gestation (antenatal sample) and 1741 women at approximately 8 weeks post delivery (postnatal sample). Measurements and findings:54% of women perceived that they exercised informed choice overall in the antenatal sample (95% CI: 51–57%) and 54% overall in the postnatal sample (95% CI: 52–56%). Perceptions of informed choice differed by decision point, varying between 31% for fetal heart monitoring during labour and 73% for the screening test for Down's syndrome and spina bifida in the baby. There were differences by maternity unit, even when the characteristics of women attending these units were taken into account. Multiparous women, women from manual occupations and women with lower educational status were more likely to feel that they exercised informed choice during antenatal care. These sub-groups of women were also more likely to report a preference for not sharing decision-making with health professionals. Conclusions: a large minority of women felt that they had not exercised informed choice overall in their maternity care. The perception of informed choice differed by decision point, maternity unit and characteristics of the woman. Implications for practice: attaining informed choice is more of a challenge for some decision points in maternity care than others, particularly fetal monitoring. The difference in levels of informed choice between maternity units highlights the importance of maternity unit policy in the promotion of informed choice.

Use of evidence based leaflets to promote informed choice in maternity care: randomised controlled trial in everyday practice

Objective: To assess the effect of leaflets on promoting informed choice in women using maternity services.Design: Cluster trial, with maternity units randomised to use leaflets (intervention units) or offer usual...

Qualitative study of evidence based leaflets in maternity care

Objective: To examine the use of evidence based leaflets on informed choice in maternity services.Design: Non-participant observation of 886 antenatal consultations. 383 in depth interviews with women using maternity services...

Improving communication between health professionals and women in maternity care: a structured review.

To review trials of the effectiveness of interventions aimed at improving communication between health professionals and women in maternity care. The electronic databases Medline, PsycLit, The Cochrane Library, BIDS Science and Social Science Indexes, Cinahl and Embase were searched. Final searches were carried out in April 2000. Controlled trials of interventions explicitly aimed at improving communication between health professionals and women in maternity care were included. Other trials were included where two reviewers agreed that this was at least part of the aim. 95 potentially eligible papers were identified, read by one reviewer and checked against the inclusion criteria. The 11 included trials were read, assessed for quality and summarized in a structured tabular form. The included trials evaluated interventions to improve the presentation of information about antenatal testing, to promote informed choice in maternity care, woman-held maternity records and computer-based history taking. Four trials in which women were provided with extra information about antenatal testing in a variety of formats suggested that this was valued by women and may reduce anxiety. Communication skills training for midwives and doctors improved their information giving about antenatal tests. The three trials of woman-held maternity records suggested that these increase women's involvement in and control over their care. The trials identified by this review addressed limited aspects of communication and focused solely on antenatal care. Further research is required in several areas, including trials of communication skills training for health professionals in maternity care and other interventions to improve communication during labour and in the postnatal period.

Midwives highlight lack of choice in maternity care

Poor planning leads to wide variation in number of births per bed, claims union

Opinions of general practioners in Nottinghamshire about provision of intrapartum care

To examine the beliefs of general practitioners concerning intrapartum care. Postal questionnaire survey. All general practitioners with patients in Nottinghamshire Family Health Services Authority in September 1993. General practitioners' current involvement in maternity care, and beliefs on intrapartum care. Of 694 general practitioners sent questionnaires, 550 (79.2%) replied. 529 of these were on the obstetric list; 437 had not attended a delivery in the past 12 months; 36 had attended two or more; 358 general practitioners did not wish to provide more intrapartum care; 349 did not feel competent to do so. Reasons for not wanting to provide intrapartum care included current workload (453), disruption to personal life (407), and the fear of litigation (377). General practitioners who already booked women for home delivery were more likely to wish to do more deliveries (62/42 v 61/316, chi 2 = 85.3; P < 0.0001) and to have more positive attitudes towards increasing women's choice in maternity care (90/22 v 195/151, chi 2 = 227; P < 0.0001). The involvement of general practitioners in intrapartum care in Nottinghamshire is low, and most general practitioners are unwilling to increase their role. However, general practitioners who already book for home delivery are keen to do more.