Background
Methods
What influences birth place preferences, choices and decision making amongst healthy women with straightforward pregnancies in the UK?
Data synthesis method
Criteria for study inclusion
Search strategy and screening methods
Study selection
Quality assessment
Data extraction and synthesis
Results
Search results
Description of included studies
Aim | Setting | Methods | Analysis | Options available to participants | Sample and sample characteristics | |
---|---|---|---|---|---|---|
To explore the factors involved in deciding to have a home birth. | London, England | Interviews | Thematic | OU or home | Postnatal (3–5 years) Mixed age and parity | |
Ogden et al. (1998) [39] | To ‘explore the experiences of women who have a contemporary commonplace hospital birth’. | London, England | In depth interviews | Thematic | OU or home (in principle) | Postnatal (within 5 years) Multiparous women |
Mansion and McGuire (1998) [28] | To explore what influences women in their choice of DOMINO birth. | Central Scotland | Interview study | Thematic | Hospital OU or DOMINO | Antenatal
n = 8 women 22–37 weeks pregnant aged 21–35. Mixed parity. |
Tinkler and Quinney (1998) [48] | To explore women’s experiences of being informed and making decisions (including choice of place of birth). | England | Mixed: interviews (n = 8) and focus groups (n = 14) | Content and thematic | Choice of OU or home birth. | Antenatal and postnatal
n = 68 Diverse socio-economic status (SES), age, parity |
Emslie et al. (1999) [29] | To examine the way women make choices and decisions about choice of place of birth | North -East Scotland | Interviews (longitudinal) | Grounded theory Thematic analysis | OU, AMU, FMU and home birth (although home birth discouraged) | Antenatal and postnatal follow up.
n = 20 mixed parity. |
Longworth et al. (2001) [35] | To identify 'valued attributes’ of home and hospital birth for women | England (London) | Focus groups (n = 2) | Analysis not described | Home or OU | Antenatal or postnatal – booked in preceding 12 months
n = 20 women participated No sample characteristics provided. |
Cheung (2002) [40] | Identify experiences of Chinese and Scottish childbearing women in Scotland | Scotland | Interviews (longitudinal) | Comparative thematic analysis | Hospital OU or home | Antenatal and postnatal follow- up
n = 20 women (Chinese n = 10, Scottish n = 10) Age 25–82. Mixed parity. |
Stapleton et al. (2002) [37] | To examine the use of evidence-based leaflets on informed choice in maternity services. | Wales (13 maternity units) | Observations (n = 886), field notes, interviews. | Grounded Theory thematic analysis | Home birth and OU | Antenatal and postnatal Antenatal interviews (n = 85) Postnatal interviews (n = 78)
NB Figures relate to entire study, not limited to Choice of Place of Birth leaflet. Theoretical sampling including diverse age, ethnicity and obstetric experiences but parity not specified. |
Madi and Crow (2003) [38] | To find out how much information women have about hospital and home birth | S England | Interviews | Grounded theory thematic analysis | Home or OU | Antenatal.
n = 33 (20 planning home birth, 13 planning hospital birth) 32–42 weeks pregnant Low risk pregnancies. Mixed parity. |
Watts et al. (2003) [47] | An evaluation of how the new midwife led service (FMU) was meeting women’s needs, from the service user perspective. | England (rural) | Unstructured interviews, observations and documentary research | Thematic analysis | Home, FMU or OU | Postnatal (within 1 year)
n = 8 Multiparous, low risk women |
Andrews (2004) [33] | Explore women’s experience of home birth | S Wales | Interviews | Phenomenological thematic analysis | Hospital OU or home | Postnatal (up to 6 m)
n = 8 Mixed parity |
Lavender and Chapple (2005) [41] | Identify models of care that meet the needs of women and offer choice of place of birth. | England | Survey, 71% response rate. Only responses to open questions within survey included. | Thematic analysis | Hospital OU, AMU, FMU, Home (National survey, options varied depending on area where participant lived). | Antenatal (mean 29 weeks)
n = 2071 women who used one of 12 maternity units in England Mixed parity mean age 29, mostly white/English speaking, diverse SES |
Shaw and Kitzinger (2005) [32] | To document the obstacles women encounter in trying to exercise their right to choose to give birth at home. | UK | Documentary data. Call transcripts and emails to the Home Birth helpline. | Content and thematic analysis | Hospital OU – home birth was an option but callers had experienced barriers to this. |
n = 56 callers to Home Birth helpline, of whom n = 54 women calling on their own behalf. No other demographic data was gathered. |
Barber et al. (2006) [34] | Identify factors that influence women’s decisions about where to give birth | S England | Focus groups (n = 5) | Content and thematic analysis | Hospital OU, FMU or home | Pregnant women (29–40 weeks). n = 20 women (Mixed parity) |
Walsh (2006) [46] | Ethnographic exploration of culture, beliefs, values, customs and practices in FMU. | England (Midlands) | Participant observation (n = 15, 6–10 h),interviews with women (n = 30, 5 of whom were observed) | Thematic analysis | FMU or OU, home. | Antenatal and postnatal (around 3 m)
n = 40 Mixed parity. |
Jomeen (2007) [31] | To explore and advance the understanding of maternity care choice through women’s experiences. | North England | Longitudinal narrative interviews | Thematic analysis | OU, home birth, FMU (new). | Antenatal and postnatal follow up.
n = 10 low risk women Parity not specified. Aged 18 or older. |
Houghton et al. (2008) [8] | To explore the rationale behind women’s choice of place of birth and the influences on their decision-making. | NW England | Observations and semi-structured interviews | Thematic analysis | OU, home birth, AMU ('integrated MLU') | Antenatal and postnatal follow up
n = 30 Mixed parity aged 18–39, 80% married/cohabiting, diverse SES |
Pitchforth et al. (2008) [36] | To explore women’s perceptions of different models of care and willingness to make ‘trade-offs’ in remote and rural areas. | Scotland Remote & rural | Focus groups (n = 8, range 4–7 participants) | Thematic analysis | OU, remote FMU or home | Postnatal women (1 m – 7 years) n = 47 participants Aged 24–45 Parous. |
Pitchforth et al. (2009) [9] | To explore women’s perceptions of “choice” | Scotland Remote & rural | Focus groups (n = 12, range 4–9 participants) | Thematic analysis | OU, remote FMU or home | Postnatal (within 4 years)
n = 70 Mixed parity. |
McCutcheon and Brown (2012) [44] | To add to the body of knowledge on place of birth and home birth experiences. | England | Interview study | Thematic analysis | Hospital OU or home | Postnatal Women (n = 9) aged 27–78 who had given birth at home at least once (n = 7) or only in hospital (n = 2). Diverse ethnicity. |
Newburn (2012) [45] | To examine lived experiences in a new birth centre (AMU) | England | Ethnography (participant observation) | Thematic analysis | AMU home or OU | Antenatal (observation) and postnatal (interviews) Postnatal women (n = 11) Mixed SES, ethnically diverse. Parity not clear, but includes multiparous women. |
Coxon et al. (2014) [10] | To understand better what accounts for birth place preferences. | S England | Interviews (longitudinal) | Narrative analysis (thematic and structural) | Hospital OU and home (all); AMU and/or FMU depending on local services. | Antenatal with end of pregnancy follow up.
n = 41 women Aged 19 to 42. Mixed parity, mixed ethnicity, diverse SES, mixed risk |
Coxon et al. (2015) [30] | To explore the influence of pregnancy and birth experiences on planned place of birth in future pregnancies | S England | Interviews (longitudinal) | Narrative analysis (thematic and structural) | Hospital OU and home (all); AMU and/or FMU depending on local services. | Antenatal with postnatal follow up
n = 41 women Aged 19 to 42. Mixed parity, mixed ethnicity, diverse SES, mixed risk |
Study quality
Findings
New sub-themes: Antenatal experiences and finding out about choice of place of birth
Making sense of differing expectations
We just assumed it would be in hospital, we didn’t really talk about it. We didn’t discuss it at all.
I think a lot of them (referring to healthcare professionals (HCPs)) make an assumption and think well, yes, you come under (name of hospital/OU)…and say, ‘you will be going along there to have the baby, won’t you?’ And, people, unless they have specifically thought about it and are willing to state, ‘well, actually, no, I won’t,’ then they will not get the option at all.