Informed Choice In Maternity Care

Factors constraining women's choices are examined from a wide range of perspectives, including service users, midwives, obstetricians and social scientists, to highlight the social, cultural and clinical factors influencing decision making.

Factors constraining women's choices are examined from a wide range of perspectives, including service users, midwives, obstetricians and social scientists, to highlight the social, cultural and clinical factors influencing decision making.

The importance of informed choice for consumers has been recognised within the NHS. The Midwives Information and Resource Service (MIDIRS), together with the NHS Centre for Reviews and Dissemination, produced leaflets summarising research evidence for ten discrete topics on which decisions are made in pregnancy. The leaflets are produced in pairs: the woman's version summarises the research evidence; the health professional's version details evidence in greater depth and is fully referenced. The leaflets were intended to provide researchbased information to inform choice in accordance with women's individual needs. This research evaluated the use of the whole set of MlDlRS Informed Choice leaflets across maternity units to assess their effectiveness in promoting informed choice. The study was conducted in two phases. The first phase comprised an ethnographic of three maternity units, which had purchased and used the leaflets for some time. This informed the development of the second phase in which a cluster randomised controlled trial (CRCT) was undertaken in conjunction with qualitative fieldwork. The qualitative research included observation of clinical practice, interviews with women and health professionals, and focus groups with women. The 13 maternity units, grouped into ten clusters; five were randomised to receive the intervention and five to act as controls. En economic study of costs and cost consequences was also undertaken. Between 92% and 99% of women who received each leaflet reported that it was helpful or very helpful. However there was no evidence that the leaftets were effective in increasing the proportion of women who reported having exercised informed choice. The qualitative research illustrated the complexity of the environment in which the intervention was applied and suggests reasons why the MIDIRS Informed Choice leaflets did not promote informed decision-making in this study.

This title is directed primarily towards health care professionals outside of the United States. This book explores the complex interrelationship between risk and choice in maternity care, taking a close look at how "high" and "low" risk are defined and what impact this has on a woman's ability to exercise informed choices throughout pregnancy. It offers an international collaboration that highlights different perspectives on debated issues, with chapters on maternity care in the UK, United States, Australia, and Ireland contributed by midwives, obstetricians, risk management experts, and sociologists. The aim of this book is to illustrate the changing reality of risk management as it relates to maternity care, and to highlight risk management concerns that may limit the choices available to pregnant women. Clarifies how applications of risk affect the choices pregnant women are able to exercise. Locates pregnancy risk considerations within the overall scheme of risk management. Analyzes practitioners' responses to the requirements of risk management. Presents risk management and choice from the risk manager's perspective, providing an understanding of risk as a "macro concept" in health care. Highlights medico-legal opinions on exercising choice, underscoring the need for accurate information and the ability to make informed decisions. Two chapters examine women's perspectives on risk labeling and the impact this has on choice - one in which the concept of safety within maternity care is discussed, and one in which the views of women with defined risk factors are explored and their ability to make choices is evaluated. Two chapters written by health service risk managers discuss the differences between an inner-city approach and a rural approach to the debate surrounding risk and choice. Discusses midwifery's focus on "normality" in childbirth and considers how this viewpoint affects the risk dialogue, including a chapter on clinical trends in maternity care. An obstetric perspective on risk refutes criticisms of obstetricians as being more likely to impose risk labels and limit choices by discussing how risks and choices are presented and considered within obstetric care. Explores the debate surrounding a woman's right to have a home birth in Ireland, in light of its risk management climate. Two chapters discuss the collaboration between service users, midwives, and obstetricians in Australia regarding the organization and delivery of maternity care, as well as the views concerning risk among indigenous Australians. Perspectives from nurse-midwives in the U.S. discuss the complex relationships among nurse-midwives, obstetricians, and pregnant women with regard to choice, including views on risk within immigrant communities.

The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.

Optimizing outcomes for women in labor at the global level requires evidence-based guidance of health workers to improve care through appropriate patient selection and use of effective interventions. In this regard, the World Health Organization (WHO) published recommendations for induction of labor in 2011. The goal of the present guideline is to consolidate the guidance for effective interventions that are needed to reduce the global burden of prolonged labor and its consequences. The primary target audience includes health professionals responsible for developing national and local health protocols and policies, as well as obstetricians, midwives, nurses, general medical practitioners, managers of maternal and child health programs, and public health policy-makers in all settings.

Birthing Autonomy brings some balance to the difficult arguments that arise from debates about home births, and focuses on women’s views and their experiences of planning home births. It provides an in-depth exploration of how women make decisions about home births and what aspects matter most to them. Comparing how differently the pros and cons of home births are constructed and contemplated by mothers and by the medical profession, the book looks at how current obstetric thinking and practices can disempower and harm women emotionally and spiritually as well as physically. Written in an accessible style, this book is enlightening for student and practicing midwives and obstetricians, as well as researchers and students of nursing, medical sociology, health studies, gender studies, feminist practitioners and theorists. It will also be invaluable to expectant mothers who want to be more informed about the choices they are facing and the wider context within which their birth options are considered.

Current maternity policy advocates choice and control for women in maternity care, and promotes women as active childbirth consumers and decision-makers. However, evidence that women receive true choice within contemporary maternity services is lacking, and continued and pervasive barriers to choice continue to have profound consequences for many. Choice, Control and Contemporary Childbirth explores the narrative childbirth experiences of a group of women, outlining current policy and providing an overview of the relevant discourses to which women are exposed when making choices for maternity care. This book is unique in presenting narratives that reveal varying identities for women across their maternity exerience, illustrating how maternity choices are simulataneously promised and constrained. It provides practitioners, service providers and policymakers in maternity care, and all those with an interest in birth provision, with profound insights into both women's experiences of childbirth and how choices can be better facilitated in future. 'Maternal choice and control are a challenge in contemporary society, with the changing demography of the population, the rising birth rate and financial constraints. Collecting this diverse information in one publication is timely and an invaluable resource for the practising and academically active midwives, obstetricians and health service managers.' - From the Foreword by Tina Lavender