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

Abstract

BackgroundEnglish maternity care policy has supported offering women choice of birth setting for over twenty years, but only 13% of women in England currently give birth in settings other than obstetric units (OUs). It is unclear why uptake of non-OU settings for birth remains relatively low. This paper presents a synthesis of qualitative evidence which explores influences on women’s experiences of birth place choice, preference and decision-making from the perspectives of women using maternity services.MethodsQualitative evidence synthesis of UK research published January 1992-March 2015, using a ‘best-fit’ framework approach. Searches were run in seven electronic data bases applying a comprehensive search strategy. Thematic framework analysis was used to synthesise extracted data from included studies.ResultsTwenty-four papers drawing on twenty studies met the inclusion criteria. The synthesis identified support for the key framework themes. Women’s experiences of choosing or deciding where to give birth were influenced by whether they received information about available options and about the right to choose, women’s preferences for different services and their attributes, previous birth experiences, views of family, friends and health care professionals and women’s beliefs about risk and safety. The synthesis additionally identified that women’s access to choice of place of birth during the antenatal period varied. Planning to give birth in OU was straightforward, but although women considering birth in a setting other than hospital OU were sometimes well-supported, they also encountered obstacles and described needing to ‘counter the negativity’ surrounding home birth or birth in midwife-led settings.ConclusionsOver the period covered by the review, it was straightforward for low risk women to opt for hospital birth in the UK. Accessing home birth was more complex and contested. The evidence on freestanding midwifery units (FMUs) is more limited, but suggests that women wanting to opt for an FMU birth experienced similar barriers. The extent to which women experienced similar problems accessing alongside midwifery units (AMUs) is unclear.Women’s preferences for different birth options, particularly for ‘hospital’ vs non-hospital settings, are shaped by their pre-existing values, beliefs and experience, and not all women are open to all birth settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1279-7) contains supplementary material, which is available to authorized users.

Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review

“…In using the 'best fit' framework synthesis approach [41], an adapted CFIR framework will be developed which goes beyond listing determinants to illustrate the relationships between factors. This approach, adopted by other recently published reviews [42][43][44][45], may help advance the a priori framework towards being more testable. For example, the adapted CFIR framework can be used to generate a hypothesis, specifically in the context of menu labelling, to be tested in empirical research.…”

Ability of women to self‐classify into the Robson ten‐group classification system

“…Previous studies showed that women who prefer a home birth expect to have greater personal autonomy, involvement in decision making with some control during the birth process, and avoidance of unnecessary intervention, whereas women who opt for a hospital birth are more often concerned about safety issues. [2][3][4][5][6][7][8][9][10][11][12][13][14] Previous studies from Netherlands and New Zealand 1,2 found that women who chose midwifery assisted units were mainly influenced by ease of access and the atmosphere of the unit; by contrast, women who chose a hospital birth were mostly influenced by the sense of safety, availability and confidence in medical staff, pain relief, and hospital facilities. Women also differed in their sociodemographic characteristics:…”

“…In view of the lack of information about these factors, there is a need to better understand women's birthplace preferences 10. Most studies of this topic focus mainly on factors that influence the choice between home, midwifery assisted, or hospital birth 11. The 2017 update of the National Institute for Health and Care Excellence guidance for intrapartum care 12 recommends that healthy women with low-risk pregnancies may choose the birth setting of their choice.…”

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

“…Thus, a picture emerged across many sites of a haphazard, muddled pathway for gaining access to MUs, which defaulted to the dominant OU model frequently. A number of authors have critiqued the framing of birthplace choice, with evidence strongly suggesting that health-care professionals may guide women's choices by offering little information about alternatives to OU birth, 121 resulting in what has been variously called 'protecting steering' 122 or 'informed compliance'. 123,124 This was also found in our media analysis.…”