A systematic review of qualitative studies of how and why women make choices about their maternity care reveals how complex women’s decision-making is.

Women turn to family friends and the internet for information on which to base their decisions, as well as valuing, in particular, informal conversations with midwives (rather than being given leaflets to read). Their choices may be related to previous significant experiences in their lives and to previous births. Ultimately, women’s decisions about, for example, place of birth, are a blend of what the authors describe as ‘physiological and social considerations’. Decisions also are made in alignment with women’s individual philosophies of birth – whether they see birth as a medical event best managed by professionals in hospital or as a domestic event, which should naturally take place in the home. The central question that every woman tries to answer for herself when making choices is, ‘What is the risk to my body and my baby?’ Home birth is the choice of women who want to maintain control over their bodies and their care.

The authors conclude that while health professionals may believe they are truly offering choice, the current model of maternity care does not support ‘fluid decision-making’. In order to break down dichotomies (between, for example, home or hospital; pain relieving drugs or none) there is a need to develop alternative models of care such as midwife-led care, continuity of carer and group antenatal care. These are models which are respectful of women’s bodily autonomy and which trust women’s experiences and beliefs. They are helping to restructure the relationship between health professionals and pregnant and birthing women.

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Read more: Yuill, C. et al. (2020) Women’s experience of decision-making and informed choice about pregnancy and birth care: A systematic review and meta-synthesis of qualitative research. BMC Pregnancy and Childbirth. doi.org/10.1186/s12884-020-03023-6