Background
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Review 1: What is known about midwives views of their discussions with women about their options for where to give birth?
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Review 2: Have any interventions been implemented to support midwives’ PoB discussions with women? If so, what were the barriers and facilitators to implementing them and have the interventions been effective?
Methods
Criteria for considering studies for this review
Types of studies
Types of participants
Types of Interventions (review 2 only)
Search methods for identification of studies
Searches | |
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1 | (birthplace or place of birth) ti,ab. |
2 | ((home or hospital or institut$ or place or locat$ or setting$) adj3 (birth$ or confine or confinement or confining or deliver$)). ti,ab. |
3 | Home childbirth.mp. or Home Childbirth/ |
4 | Delivery, Obstetric/px |
5 | 1 or 2 or 3 or 4 |
6 | (choice or preference or decision$ or dialog$ or discussion$ or consultation$ or conversation$ or communication$ or attitude$ or perspective$ or view$). Ti,ab. [mp = title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, unique identifier] |
7 | Patient Preference/ |
8 | (Women$ adj3 Preference$).ti,ab |
9 | Midwifery/ |
10 | (midwife$ or midwives)ti,ab. [mp = title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, unique identifier] |
11 | 6 and 10 |
12 | 7 or 8 or 9 or 11 |
13 | 5 and 12 |
Selection of studies
Data extraction and risk of bias
Study | Study country | Midwifery setting | Study aim | Study design | Analysis methods | Number of participating midwives | Total Risk of Bias within study |
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Barber et al (phase 1). 2006 [15] | UK | Two NHS Trusts, each with obstetric units, alongside and free-standing maternity led units and homebirth services. | To identify factors that influence women’s decisions about where to give birth. | Qualitative. Focus groups with midwives. | Thematic analysis. | 16 | High |
Davis et al. 2010 [16] | New Zealand | Case-loading midwives, so move between home to hospital. | To explore the way case-loading midwives construct midwifery and to examine their practice within the obstetric hospital | Qualitative, in-depth interviews. | Thematic analysis. | 48 | High |
Feminist, post-structuralist framework. | |||||||
Lavender et al. 2004 [17] | UK | 14 sites, comprising home birth settings, free-standing midwifery-led units, alongside midwifery-led units and obstetric units. | To explore the views of midwives working in maternity services, in relation to birth setting, models of care and philosophy of care. | Qualitative. Focus groups with midwives. | Thematic analysis. | 126 | Low |
Appreciative inquiry. | |||||||
RCM, 2011 [18] | UK (97 %, n = 536) and outside of UK (3 %, n = 17) | Community, integrated community and hospital setting, midwifery led units, hospital obstetric unit and other settings. | To gain a national picture of midwives’ current thinking about home birth practice and to identify areas of concern by midwives and any education and practice needs in this area. | Quantitative. Online survey. | Descriptive statistics. | 553 | High |
Vedam et al. 2009 [19] | North America | Urban centres, rural areas and a mixture of both settings. | To describe the attitudes and experiences of midwives toward planned home birth and to explore evidence-based correlates and predictors of their attitudes toward planned home birth. | Quantitative. Online and paper survey. | Descriptive statistics; correlation analysis. | 1893 | High |
Vedam et al. 2012 [20] | Canada | Registered midwives working in any setting. | To describe educational, practice and personal experiences related to home birth among obstetricians, family physicians, and registered midwives; to identify barriers to provision of planned home birth services and examine inter-professional differences in attitudes towards planned home birth. | Quantitative. Online survey. | Descriptive statistics; correlation analysis. | 451 | High |
Study | Study country | Midwifery setting | Study aim | Study design | Analysis methods | Number of participating midwives | Total Risk of Bias within study |
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Barber et al (phase 2). 2006 [12] | UK | Two NHS Trusts, each with obstetric units, alongside and free-standing maternity led units and home birth services. | To implement educational, marketing and change management initiatives on and around informed choice and place of birth. This included relaunching the Birth Centres at both Trusts, the provision of local evidence-based leaflets with information on all the birth place options and Birthplace Choices websites for each Trust. | Qualitative Interactive, educational interventions with midwives. | Qualitative feedback from intervention session. | 38 participated in workshops. | High |
Barber et al (phase 3). 2007 [22] | UK | Two NHS Trusts, each with obstetric units, alongside and free-standing maternity led units and home birth services. | To evaluate which initiatives helped midwives promote informed choice around place of birth. To identify if more women had subsequently chosen an out of hospital birth. | Quantitative survey study with midwives. | Descriptive statistics. | 150 | High |
Kirkham et al. 2001 [21] | UK | Three maternity units, encompassing community, hospital, integrated hospital and community case-loading and specialist roles. | To assess the impact of the MIDIRS Informed Choice Leaflets (for health professionals) on health professionals. | Qualitative ethnographic and interview study. | Ethnographic field notes and grounded theory approach to interview analysis. | 177 | Unclear |
Rogers et al. 2015 [13] | UK | One large hospital maternity unit | To improve informed choice and the knowledge and confidence of midwives around place of birth using workshops for women and midwives, ‘decision aid’ tools and changes to the midwifery rota. | Mixed methods: Workshops and survey study. | Qualitative feedback from workshops. | Not reported. | High |
Descriptive statistics to summarise survey data. | |||||||
Walton et al. 2014 [11] | UK | One large hospital maternity unit | To increase the number of women having a clear preference for place of birth, ideally by 36 weeks, using the Birthplace app intervention (introduced at 25 weeks). | Quantitative. Pilot controlled study. | Descriptive statistics. Retrospective analysis of data collected at booking visit, 12 and 36 weeks on women’s choice of place of birth setting. | 35 | High |
Missing data
Data synthesis
Results
Characteristics of included studies
Review 1: Midwives views of the discussions with women about their options for where to give birth
Resource issues | Organisational and professional norms | Influence of midwifery colleagues | Midwives’ perspectives on their role in women’s decision-making | Confidence of midwives | Strategies for improvement |
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• Lack of midwifery staff • Time pressures • Resource implications (unit closures) | • Hospital policies/organisational pressures • Peer opinion • Pressure to conform to status quo • Concerns about litigation | • Conflicting opinions about place of birth settings • Lack of homebirth promotion • Unsupportive attitudes towards homebirth | • Importance of offering range of choices • Booking visit wrong time for discussion • Women’s decision-making unaffected by discussion • Cultural/societal factors, and parity, influence women’s decision-making • Women’s responsibility to explore options • Importance of revisiting options with women | • Varying levels of confidence around discussing homebirth • Unwillingness and uncertainty of offering homebirth • Lack of skill and confidence in different birth settings | • Training in discussion of risk and promotion of homebirth • Leaflet focusing on birthplace choices for women |
Qualitative studies
Quantitative studies
Study findings
Effectiveness of intervention | Barriers to implementation |
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• Kirkham et al. (2001) [21] No evidence that leaflets effective in increasing women’s informed choice. Non-significant reduction in planned hospital birth. • Rogers et al. (2015) [13] Women who attended workshops and received decision aid tool more likely to be offered a choice of place of birth and receive sufficient information. Admissions to alongside midwifery led units increased, admissions to free-standing midwifery led units decreased and home births remained constant. • Walton et al. (2014) [11] More women decided a preferred place of birth setting following introduction of app. Absence of comparator group. Midwives found app useful communication tool. • Barber et al. (2007): No results reported on intervention effectiveness. Midwives increasingly engaged and tried to disseminate more leaflets to women. Most midwives found leaflet and multi-professional guideline useful, and a few subsequently changed their practice. Increase in women choosing out-of-hospital births reported in one Trust, a decrease reported in the other. | • Midwives’ personal experiences, views and philosophies influenced type of information and support given. • Limited information provided, depending on assessment of women’s risk • Difficulties providing sustainable home birth service. • Little value placed on leaflets as vehicles for change • Maintaining the status quo • Inappropriate use of leaflets |