Women's perspectives of decision-making for labour and birth: a qualitative antenatal-postnatal paired interview study.

objectivesTo understand and compare women's antenatal and postnatal views on: (1) priorities for information provided about labour and delivery and (2) decision-making in labour and delivery.

designQualitative interview study using repeat interviews at two time points: during pregnancy (≥13 weeks gestation); and after birth (≥6 weeks).

settingLarge maternity hospital in the Southwest of England.

participantsPregnant women accessing antenatal care were purposively sampled and recruited antenatally by community midwives to ensure representation from different sociodemographic groups, with diverse experiences of low and high-risk care. DATA COLLECTION: Telephone interviews with a single researcher using a semistructured interview topic guide. DATA ANALYSIS: Interviews were audio recorded, transcribed verbatim, and qualitative thematic analysis was conducted using Braun and Clarke's six-stage process.

resultsTwelve women participated (12 antenatal interviews; 10 follow-up postnatal interviews). Overall, women's postnatal views were consistent with their antenatal views about what they wanted to know and the factors that influence decision-making. Three themes were generated. Theme 1 'Sources of information' presents evidence of how women obtain and use information (sub-themes: 'social influences', 'patient responsibility for information seeking', 'NHS vs non-NHS resources'). Theme 2 reports women's views and experiences of 'The influence of Healthcare Professionals in decision-making' (sub-themes 'patient and professional roles in decision-making', 'conflicting advice and preferences', 'taking authority in emergency decision-making'). The final theme, theme 3, 'When, how, and what information women want' shows women want time to process information (sub-themes 'when: it's definitely information and time', 'how: presentation of information', 'what: information required'). Cross-cutting all themes, we found an unmet need for information to be tailored to the individual.

conclusionsWomen understand decision-making during labour and birth is a dynamic process. Women can struggle with the volume, quality and timing of information available. In busy maternity settings, the challenge is to better equip women with the information they want, and health professionals with the information they need to provide for personalised care and shared decision-making. Antenatal interventions that warrant further research include decision aids, birth plans, and structured counselling using core information sets. Insights from both antenatal and postnatal perspectives will help inform their development.