Research: Women's information needs when choosing where to give birth
It is now over five years since the Birthplace research was published.
The revised NICE intrapartum care guideline (2014) incorporates Birthplace evidence and contains clear recommendations about how clinicians can support women at low risk of complications to choose where to give birth. After Birthplace, further research was commissioned to address policy questions around women’s choices, and the first phase of this project has now finished. This included two linked systematic reviews, and a focus group study, to explore women’s experiences of birthplace choice and decision-making.
The first review was a synthesis of quantitative evidence (Hollowell et al, 2016), which was conducted to identify women’s birthplace preferences, and to examine which attributes or aspects of services are prioritised by women at low risk of complications. The review included four surveys and five ‘stated preference’ studies published since 1992, a timeframe chosen to reflect the post-Changing childbirth policy era. The review found that women valued services being local to them, access to pain relief options and having a known midwife. Women also preferred being involved in decisions, and a substantial proportion valued being in a hospital environment with medical facilities available if needed.
The second, linked systematic review (Coxon et al, 2017) used the same protocol but explored qualitative data on the same topic, and identified 24 papers with interview and focus group data, from the same timeframe. This review found that women’s experiences of choosing where to give birth was influenced by the amount of information they received, their previous experiences and the views of family and friends. There was also evidence that women’s perceived access to choices of different settings varied, and while it was fairly straightforward to opt to give birth in a hospital obstetric unit, those who were considering birth at home or in a midwifery unit sometimes found their preferences were questioned, by clinicians and their partners and families.
Both systematic reviews identified limitations in the methodological quality of included papers, and a further issue was that the data for included studies was gathered before Birthplace findings were published, and also pre-dated the revised NICE guidelines. An additional study therefore aimed to provide qualitative evidence about women’s choice and decision-making since these became available. The authors conducted eight focus groups, which explored different aspects of women’s experiences of choosing where to give birth. The first published paper from this study (Hinton et al, 2018) focused on information needs and preferences, and found that women draw on lots of different sources and the midwife was not the main source. Women appear to encounter fewer obstacles to choice than in the past, but still report inconsistent information, and preferred having time to consider and revisit options during pregnancy.
Kirstie Coxon is associate professor at Kingston and St George’s
Coxon K, Chisholm A, Malouf R, Rowe R, Hollowell J. (2017) What influences birth place preferences, choices and decision-making amongst healthy women with straightforward pregnancies in the UK? A qualitative evidence synthesis using a 'best fit' framework approach. BMC Pregnancy and Childbirth 17(1): 103. See: https://doi.org/10.1186/s12884-017-1279-7
Hinton L, Dumelow C, Rowe R, Hollowell J. (2018) Birthplace Choices: what are the information needs of women when choosing where to give birth in England? A qualitative study using online and face to face focus groups. BMC Pregnancy and Childbirth 18(1): 12.
Hollowell J, Li Y, Malouf R, Buchanan J. (2016) Women’s birth place preferences in the United Kingdom: a systematic review and narrative synthesis of the quantitative literature. BMC pregnancy and Childbirth 16(1): 213 https://doi.org/10.1186/s12884-016-0998-5
NICE. (2014) Intrapartum care for healthy women and babies. See: nice.org.uk/guidance/cg190 (accessed 13 March 2018).