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Table 4 Summary of included studies

From: Women’s experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research

Reference number

Study

Country

Study aims

Participants, setting

Study design, data collection, analysis

Quality

[31]

Andrews, 2004

United Kingdom

To explore women’s experiences of home birth

• 8 women who had planned a home birth in the six months before the study

• South Wales

• Qualitative interview study

• Semi-structured interviews using open-ended questions

• Thematic analysis using a phenomenological approach

M

[32]

Bedwell, et al., 2011

United Kingdom

To explore expectant fathers’ views of birth setting

• 37 expectant fathers, 19 of which were interviewed

• North West of England

• Qualitative interview study using interpretive approach

• Semi-structured interviews in women’s 34th week of pregnancy

• Thematic analysis

M

[33]

Bernhard, et al., 2014

United States of America

To explore why women choose home birth and their perceptions of their birth experiences

• 20 women who had a hospital birth and subsequently chose a home birth

• Not stated

• Qualitative description study

• Five focus groups conducted with participants

• Qualitative content analysis

M

[34]

Catling, et al., 2014

Australia

To explore what influences women who chose a publicly-funded home birth in one state in Australia

• 17 women who chose a publicly-funded home birth

• Suburbs of Sydney, Australia

• Qualitative interview study using a constructivist grounded theory approach

• Semi-structured interviews were conducted with participants

• Analysis method not stated

M

[35]

Catling-Paull, et al., 2010

Australia

To explore the reasons why multiparous women feel confident to have a home birth within a publicly-funded model of care in Australia.

• 10 multiparous women who chose to have a home birth within a publicly funded care model

• Not stated

• Qualitative interview study

• Postnatal semi-structured interviews using open-ended questions

• Thematic analysis

M

[36]

Cheung, 2002

United Kingdom

To provide insights into how women’s birth experiences can be improved

• 10 Scottish and 10 Chinese pregnant women

• Scotland

• Qualitative study

• Four semi-structured interviews (antenatal and postnatal) with the 20 expectant mothers

• Thematic analysis filtered through participant observation

H

[37]

Coxon, et al., 2014

United Kingdom

To examine the extent to which approaches to risk can enhance understandings about birthplace decision-making

• 41 women who access maternity services

• Two inner-city area and one semi-rural area in the United Kingdom

• Longitudinal narrative study

• Three interviews with all participants

• Thematic narrative analysis

H

[38]

Coxon, et al., 2015

United Kingdom

To explore the influence of pregnancy and birth experiences on women’s current and future place of birth decisions

• 41 women who access maternity services

• Two inner-city area and one semi-rural area in the United Kingdom

• Prospective, longitudinal narrative study

• Three interviews with all participants

• Thematic and structural narrative analysis

M

[39]

Dahlen, et al., 2008

Australia

To explore the experiences of first-time mothers who gave birth either at home or in the hospital in Australia

• 19 first-time mothers

• Not stated

• Qualitative study using a grounded theory approach

• In-depth interviews were conducted with participants 6 weeks after they had given birth

• Grounded theory analysis procedure using open, axial and selective coding

M

[40]

DiFilippo, 2015

Canada

To examine women’s learning when choosing to give birth at home with a midwife using a critical feminist approach

• Seven women who planned a midwife-attended home birth in the two years prior

• Ontario, Canada

• Qualitative study

• Semi-structured interviews

• Close textual analysis in order to identify themes

M

[41]

Feeley & Thomson, 2016

United Kingdom

To explore what influences women’s decisions to free birth within the United Kingdom

• 10 women planning to freebirth

• Not stated

• Qualitative study using an interpretive phenomenological approach

• Narratives and in-depth interviews were conducted with participants

• Analysis guide by Heidegger and Gadamer’s interpretive phenomenological concepts

H

[42]

Grigg, et al., 2014

New Zealand

To explore and report what influences women’s decision-making about place of birth in New Zealand

• 37 women from the larger study cohort (n = 702)

• Christchurch, New Zealand

• Mixed methods study

• Qualitative data generated from focus groups conducted in Christchurch

• Inductive content analysis

M

[43]

Grigg, et al., 2015

New Zealand

To explore women’s birthplace decision-making; to identify what enables a women to plan giving birth in freestanding midwifery-led unit rather than an obstetric unit

• 37 women from the larger study cohort (n = 702)

• Christchurch, New Zealand

• Mixed methods prospective cohort study

• Eight focus groups were conducted

• Thematic analysis

M

[44]

Happel-Parkins & Azim, 2016

United States of America

To explore and contextualise the experiences of first time mothers who planned a natural birth (e.g. No medical intervention)

• 6 first-time mothers

• Midsouthern region of the United States

• Narrative inquiry study

• Semi-structured, life-story interviews were conducted

• Thematic analysis

H

[45]

Jimenez, et al., 2010

Canada

To explore women’s birth experience in the context of the changes that have occurred in perinatal care since the 1970s; to examine how acquired information and knowledge about birth and pregnancy influence women’s birth experiences

• 36 pregnant women (26 from Montreal, 10 from Vancouver)

• Montreal and Vancouver, Canada

• Qualitative interview study

• Two semi-structured interviews at 4–6 weeks before birth and 6–8 weeks after birth were conducted with participants

• Thematic analysis

M

[30]

Lagan, et al., 2011

Australia, Canada, New Zealand, United Kingdom and United States of America

To build on previous quantitative studies on women’s internet usage for pregnancy-related information; to explore women’s experiences and perceptions of using the Internet for pregnancy-related information and its influence on their decision-making

• 92 women from five countries

• Online, specific regions not stated

• Global study drawing on interpretative qualitative traditions

• 13 asynchronous online focus groups

• Inductive thematic analysis using Ritchie and Spencer’s framework

M

[46]

Lally, et al., 2014

United Kingdom

To explore how women can be better supported when preparing for and making decisions about pain management during pregnancy and labour

• 32 pregnant women

• North east region of England

• Qualitative interview study

• Semi-structured interviews conducted when women were 28–36 weeks pregnant and six weeks after they gave birth

• Thematic analysis

M

[47]

Lee, et al., 2016

United Kingdom

To examine the decisions about place of birth among women with high-risk pregnancies, who were planning either home or hospital births

• 26 women with high-risk pregnancies, who were at least 32 weeks gestation

• Not stated

• Qualitative interview study

• Semi-structured interviews

• Inductive thematic analysis

H

[48]

Levy, 1999

United Kingdom

To explore the processes involved when women make informed choices during pregnancy

• 17 pregnant women receiving care in different maternity settings

• East Midlands, England

• Qualitative study using grounded theory approach

• Observation during booking appointments of 12 women, with follow-up interviews

• Five interviews and one observation with women who were 32–38 weeks pregnant to aid theory construction

• Thematic analysis using a grounded theory approach

M

[49]

Lothian, 2013

United States of America

To explore women’s experiences of planning, preparing for and having a home birth in the United States

• 13 pregnant women who were planning a home birth in the United States

• Not stated

• Ethnography

• Informal interviews and participant observation during participants’ pregnancies and after the births of their babies

• Thematic analysis following Lincoln and Guba’s guidelines

M

[29]

Madi, 2001

United Kingdom

To explore pregnant women’s decisions about place of birth and what influences their preferences

• 33 pregnant women (20 planning a hospital birth, 13 planning a home birth

• Not stated

• Qualitative interview study

• Semi-structured interviews were conducted with all participants

• Thematic analysis

H

[50]

Malacrida, 2015

Canada

To examine how women learn about birth and make choices using a critical feminist perspective

• 40 expectant and new mothers

• Red Deer and Lethbridge, Alberta, Canada

• Qualitative interview study

• Qualitative, semi-structured interviews

• Thematic analysis

M

[51]

Mander & Melender, 2009

Scotland,

Finland and New Zealand

To examine if choices and decision-making could be enhance for pregnant women in Scotland; to inform the organisation of Scottish maternity services

• 4 women who use the maternity services

• Not stated

• Qualitative study using a hermeneutic phenomenological approach

• In-depth, semi-structured conversations

• Modification of Colaizzi’s analysis procedure for phenomenological research

H

[52]

Miller & Shriver, 2012

United States of America

To explore women’s perceptions and decision-making regarding birth in an American context

• 135 women who chose either a home birth with a midwife, an unassisted home birth or a hospital birth

• Southeastern region of the United States

• Three phase qualitative and ethnographic study

• Phase one involved interviews with 60 women, phase two involved in-depth interviews with 21 interviews supplemented by a dataset of 127 birth stories and phase three was an ethnography of birth in an American obstetric unit

• Line-by-line coding analysis of interview transcripts and database birth stories

• Contextual analysis of field notes

H

[53]

Murray-Davis, et al., 2012

Canada

To increase understanding of why women decide to have a home birth; to describe what influences women’s decision to plan a home birth

• 34 women who were either pregnant and planning a home birth or who had planned a home birth in the last two years

• Ontario and British Columbia, Canada

• Qualitative interview study using a grounded theory approach

• Semi-structured interviews

• Thematic analysis

M

[54]

Pitchforth, et al., 2009

United Kingdom

To explore women’s experiences of choice of birthplace in remote and rural area where different models of maternity services

• 70 women who had given birth in the prior 7 years

• Remote and rural areas of North Scotland

• Qualitative focus group study

• 12 focus groups at eight study sites

• Analysis using an inductive thematic approach

H

[55]

Regan, et al., 2013

United States of America

To examine the factors that influence women’s decisions about birth and how this affects caesarean section use

• 49 first-time mothers between the ages of 21 to 36, who were in their 28-36th week of pregnancy

• Not stated

• Mixed methods study

• Focus groups and structured postpartum interviews with all participants

• Analysis using the Consensual Qualitative Research method

H

[2]

Stapleton, et al., 2002

United Kingdom

To examine how evidence-based leaflets about informed choice are used in maternity services

• Pregnant women were recruited from maternity units

• Cohort size not reported

• Not stated

• Randomised controlled trial using qualitative methods

• 886 non-participant observations of antenatal consultations and 173 in-depth, semi-structured interviews (85 antenatal, 78 postnatal)

• Not stated

M

[56]

Song, et al., 2012

United States of America

To explore how white women use the Internet during their experiences of conception, pregnancy and birth

To examine the extent to which this usage aids in making meaningful choices and shapes their patient identities

• 32 women who identified as Caucasian

• Southeastern region of the United States

• Qualitative interview study using grounded theory approach

• Interviews were conducted with each of the 32 participants

• Thematic analysis using the inductive approach of grounded theory

M

[57]

Viisainen, 2001

Finland

To explore how cultural models of birth and current practical choices influence parents’ understanding of home birth; to examine women’s reasons for and experience of planning a home birth

• 21 women and 12 men who had planned to give birth at home within the prior three years

• Not stated

• Qualitative interview study

• Unstructured interviews with open-ended questions were conducted with 12 couples and nine mothers

• Narrative structuring used for analysis

M

[58]a

Borrelli, et al., 2017

United Kingdom

To explore what influences first-time pregnant women’s choice of birthplace; to examine women’s expectations of the midwife’s role in different birthplaces and what they perceive as safe in regards to different settings

• 14 women in good general health expecting their first baby, with a low-risk pregnancy and anticipating a straightforward birth

• England

• Qualitative interview study using Straussian grounded theory methodology

• Semi-structured interviews were conducted with 14 women in-person

• Strauss and Corbin analytical grounded theory approach

H

[59]a

Hinton, et al., 2018

United Kingdom

To examine what factors are important to women when making a choice between different birthplaces; which attributes of maternity services women value; what services are needed for NHS trusts to provide women a realistic choice of home birth; what are the effects of travel time and distance on women’s choices; how women access and evaluate information about birthplace options

• 69 women in their last trimester of pregnancy

• Online (England), London

• Qualitative focus group study

• Seven focus groups conducted online on a bespoke web portal, one conducted face-to-face

• Analysis employing a combination of a thematic framework and the ‘One Sheet of Paper’ method

M

[60]a

Hollander, et al., 2017

The Netherlands

To explore the motivations of Dutch women who have chosen to give birth ‘outside the system’ (e.g. against medical advice and/or guideline/protocol)

• 28 women who had chosen to ‘birth outside of the system’ for one or more of their pregnancies

• Not stated

• An exploratory qualitative research design with a constructivist approach and a grounded theory method

• In-depth interviews with 28 women, one focus group

• Thematic analysis using open, axial and selective coding

H

[61]a

Leon-Larios, et al., 2019

Spain

To explore the perceptions, beliefs and attitudes of women who opted for a home birth in Andalusia, Spain

• 13 women who had chosen a home birth in the past five years

• Andalusia

• Qualitative interview study with phenomenological approach

• Face-to-face semi structured interviews

• Thematic analysis using a phenomenological approach

M

[62]a

Naylor Smith, et al., 2018

United Kingdom

To identify the factors that influence women’s choice of place of birth, and

to explore their views of home birth

• 28 low-risk, multiparous women

• Large, ethically diverse city in the UK

• Qualitative focus group study with interpretative approach

• Five focus groups with 28 women in routine mother and baby groups

• Thematic analysis using the Framework Method

M

[63]a

Patterson, et al., 2017

New Zealand

To explore retrospectively the choice of birth place decisions and the labour and birth experiences of women living in remotely zoned, rural areas of New Zealand

• 13 women living in a remote rural area who had given birth in the past 18 months

• Rural Otago and South Isand

• Qualitative interview study using a pragmatic interpretative approach

• Semi-structured interviews with participants, field notes

• Thematic and content analysis using Aronson’s pragmatic approach

M

[64]a

Tayyari Dehbarez, et al., 2018

Denmark

To investigate pregnant women’s decision making in relation to their choice of birthing hospital and, in particular, their priorities regarding hospital characteristics

• 13 low-risk pregnant women in their first trimester who had attended their first antenatal consultation and had been presented with a choice of hospitals

• Central Denmark Region

• Qualitative interview study

• Semi-structured interviews, with follow-up interviews conducted over the phone

• Thematic analysis

M

  1. a Denotes results from the second search conducted in August 2019