Shared Decision-Making Regarding Place of Birth–Mission Impossible or Mission Accomplished?
DOI:
https://doi.org/10.17140/WHOJ-3-120Keywords:
Shared-decision making; Midwifery; Antenatal care; Pregnancy; Place of birth.Abstract
Aim: To explore Dutch pregnant women’s experiences of shared-decision making about place
of birth to better understand this process for midwifery care purposes.
Design: Qualitative exploratory study with a constant comparison/grounded theory design.
Methods: We performed semi-structured interviews, including two focus groups and eight
individual interviews among 16 primarous and multiparous women with uncomplicated
pregnancies. Consent was obtained and interviews were audiotaped and fully transcribed. The
interviews were analyzed utilizing a cyclical process of coding and categorizing, following
which the themes were structured based on the three-step shared-decision making model of
Elwyn.1
Results: We identified the three themes according to Elwyn’s model: Choice talk, Option talk
and Decision talk. We expanded the model with one additional theme: Decision ownership. The
four themes explained women’s decision making process about place of birth. Women perceived
shared-decision making about place of birth as a decision to be taken with their partner instead
of with the midwife. Women and their partners regarded the decision about place of birth as a
choice to be made as a couple and expecting parents; not as a decision in which the midwife
needs to be actively involved. Women and their partners considered their options and developed
a strong preference about where to give birth; even before the initial contact with the midwife
was made. Involvement of the midwife occurred during the later stages of the decision-making
process, where the women sought acknowledgement of their choice which was already made.
Conclusion: Women considered their partners as the most and actively involved in the shareddecision making process regarding the place of birth. The women’s decision-making process
about the place of birth did not fully occur during the antenatal care period. The midwife should
ideally be involved before or during the early stages of pregnancy to facilitate the process.
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