https://orcid.org/0000-0002-8138-4741
Abstract
This scoping review seeks to improve our understanding of how pregnant women and their partners make decisions related to pregnancy. A total of 43 articles were included in which four themes were identified: [1] decision-making authority, [2] communication between decisional partners, [3] informational needs/knowledge, and [4] involvement/support of the partner. The extent to which couples make decisions together depends on cultural aspects, existing power relationships, the amount of information received by both partners, the type of decision and the consequences of the decision. While many male partners prioritize female autonomy in pregnancy-related decisions, contextual factors such as income and cultural influences can affect women’s autonomy. Additionally, the research emphasizes the importance of couple autonomy, asserting that joint decision-making can positively contribute to the decision-making process of couples navigating pregnancy-related choices.
Introduction
During pregnancy, expectant parents face numerous decisions relating to issues such as the place of delivery and mode of birth (e.g. vaginal or cesarean section), prenatal screening, prenatal diagnosis, and termination of pregnancy.
Due to the uncertain and value-sensitive nature of the possible outcomes of pregnancy-related decisions, they can be difficult to make and require careful deliberation (Dugas et al., Citation2012). While much of the research on pregnancy-related decisions focuses on the perspective of the pregnant woman (Osamor & Grady, Citation2018), there remains a gap in understanding how couples make decisions together, as decisional partners. A decisional partner refers to someone who shares the decision-making process with another person who is not their health care professional (Gray et al., Citation2019). In the context of pregnancy-related decisions, the decisional partner is most often the co-parent. Throughout this article, we use the term couples to refer to decisional partners, who are predominantly (future) parents. Additionally, we refer to women if we talk about the pregnant partner. It is important to acknowledge that not all pregnant people identify as women, but we have chosen to use women and feminine prepositions based on the biological ability to bear children.
Previous research has shown that women perceive their partners as important decisional partners and involving them can enhance the quality of the decision-making process regarding pregnancy-related decisions (Carroll et al., Citation2012; Farrell et al., Citation2019; Matar et al., Citation2020). The decision-making process should enable them to weigh options and reach decisions that fit both of them resulting in a consensus decision (Matar et al., Citation2020). This is important as satisfaction with the pregnancy experience is influenced not only by the quality of the decision-making process but also by the outcomes such as having a healthy child (Dugas et al., Citation2012).
Moreover, pregnancy-related decisions impact not only the pregnant woman, but also her decisional partner. Currently, insight is lacking in the joint decision-making process about pregnancy-related issues among couples and factors that may hinder or facilitate this process. When both partners are involved in decisions that affect each of them, it is likely that more options and viewpoints will be discussed and explored. As a result of this increased deliberation, couples are likely to be more satisfied with the outcomes of the decision-making process (Osamor & Grady, Citation2018).
The purpose of this review is to synthesize the existing literature to gain better understanding of how pregnant women and their partners decide on pregnancy-related issues and explore factors that influence the joint decision-making process. Therefore, our guiding research question is: What insights can be gleaned from existing scientific literature regarding the decision-making process and dynamics of couples regarding pregnancy-related decisions? The results from this study may be of interest to health care professionals, researchers, and policy makers as they may provide helpful insights into the nature of the joint decision-making process and possible ways of optimizing partner involvement.
Methods
To answer the research question, a scoping review was conducted. A scoping review is a systematic approach to knowledge synthesis in which reviewers map the results of studies on a specific topic and identify concepts, theories, and gaps in literature (Tricco et al., Citation2018). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was used to guide this scoping review (Tricco et al., Citation2018).
Eligibility Criteria
In this scoping review, articles reporting scientific studies were included if they were published in the English language between 1980 and 2021. Studies were eligible if they included parents, couples, or decisional partners (aged 18 years or older) who were involved in decision-making about pregnancy-related topics. Included study designs comprised cross-sectional studies, longitudinal studies, randomized controlled trails (RCTs), qualitative studies, and observational studies.
Articles were excluded if they lacked information on decision-making outcomes or if they were related to preconception only. Reviews and articles that remained inaccessible, even after contacting the authors, were also excluded. Throughout this review, we use the term partner to refer to the decisional partner, mostly the other parent of the future child.
Information Sources and Search
An experienced research librarian (MS) was consulted to assist with the development of the search strategy and search terms and the identification of relevant databases. The final search strategies were developed by MS and one of the researchers (YS). The systematic literature search was conducted in five databases: PubMed, CINAHL, PsycInfo, Web of Science, and Embase. The search strings were related to pregnancy, decision-making, and partners. For a full overview of the search strings, see Appendix A. The final search was conducted on 29 September 2021 and results were uploaded in EndNote. This resulted in 15,861 articles. After removal of duplicates, 9,622 were screened on title. After title screening, 243 titles remained for abstract screening and 94 for full-text screening (see ). Title, abstract, and full-text screening were conducted by two researchers (YS and ESK.) independently. Differences between YS and ESK were resolved in regular meetings. As a last step, hand-searching of the reference list was performed by YS on the articles that were included in this review to identify further relevant studies. However, no further articles were identified.
Figure 1. PRISMA flow diagram for a scoping review (Page et al., Citation2021).
Data Extraction
A data-extraction table was developed by one researcher (YS). Two authors (YS and ESK) independently extracted data from all selected articles. Disagreements were discussed with another member of the research team when required (SvdH).
Synthesis of Results
Data were abstracted based on different characteristics (e.g., country of origin) and on contextual factors (e.g., type of decision such as prenatal screening or pregnancy termination). For more information on these characteristics, see . The studies were categorized according to different themes identified through an inductive approach: [1] decision-making authority, [2] communication between partners, [3] informational need/knowledge, and [4] partner involvement.
Table 1. Characteristics of the included full-text articles.
Results
Characteristics of Included Studies
This scoping review included 43 articles. Most studies (n = 32) were conducted in Western countries. Of the studies conducted in non-Western countries (n = 11), most originated in Africa (n = 6). Most studies involved qualitative research (n = 33), some were quantitative (n = 7), and three studies used a mixed-methods approach. The study sample of most studies included couples (male and female partners) (n = 24) whereas others included only one partner (male (n = 10) or female (n = 9)). The studies pertained to various subjects; namely, prenatal screening (n = 13), prenatal diagnosis (n = 8), prenatal screening and diagnosis (n = 2), termination of pregnancy (n = 12), health care during pregnancy (n = 3), and mode of birth and place of delivery (n = 5). A full overview of the characteristics of the studies can be found in .
Themes in Relation to Decision-Making
Theme 1: Decision-Making Authority
This theme is concerned with the question of who has (the main) decision-making authority. This theme is divided into different subthemes related to the decision-making context: prenatal screening, prenatal diagnosis, termination of pregnancy, health care during pregnancy, and mode of birth and place of delivery.
Prenatal Screening
In six studies concerning prenatal screening, participants indicated that both partners of a couple should be involved in decision-making. In most of these studies couples jointly decided whether to undergo screening, or not (Åhman et al., Citation2012; Barr & Skirton, Citation2013; Carroll et al., Citation2012; Gottfredsdóttir et al., Citation2009; Laberge et al., Citation2019; Millo et al., Citation2021). These studies were conducted across Europe, North America, China, and Australia. However, participants in a study conducted in the United States indicated that, as the woman is pregnant, she should make the final decision (Werner-Lin et al., Citation2016). In a study conducted in China (Dong et al.,Citation2021), some interviewees indicated that pregnant women should have the right to make the final decision about participation in prenatal screening, whereas others agreed that the decision should be shared with their nonpregnant partner due to shared parenthood and responsibility for the future child (Dong et al., Citation2021). Similarly, in an Australian study, pregnant women indicated that they believed the pregnant woman had a strong influence in the decision on screening uptake (Jaques et al., Citation2004).
Prenatal Diagnosis
In two studies, conducted in the United States and Canada, women emphasized the importance of having the final say in decision-making regarding prenatal diagnosis (Browner & Preloran, Citation1999; Humphreys et al., Citation2008). For example, some women argued that they would opt for prenatal diagnosis, even if their nonpregnant partner would disagree (Browner & Preloran, Citation1999; Humphreys et al., Citation2008).
In other studies (United States, Sweden, and Portugal), couples described their decision-making process as joint (Carlsson & Mattsson, Citation2018; Nazaré et al., Citation2011; Phipps & Skirton, Citation2017; Sjögren & Uddenberg, Citation1988), although nonpregnant partners generally indicated that they were less involved in the decision-making (e.g., less information gathering) than their pregnant partner (Humphreys et al., Citation2008; Nazaré et al., Citation2011; Sjögren, Citation1992; Sjögren & Uddenberg, Citation1988). A study by Nazaré and colleagues (Citation2011) suggested that a positive dynamic within the couple can contribute to the involvement of the male partner in an amniocentesis decision. When men felt more valued and appreciated by their partners, they were more likely to perceive the amniocentesis decision as a joint one, leading to higher couple’s agreement (Nazaré et al., Citation2011).
In several other studies, conducted in the United States, couples reached their decisions with varying degrees of ease or deliberation. Couples who perceived the decision-making process regarding antenatal diagnosis as complicated, indicated a need to explore their partners’ perspectives and beliefs. Moreover, these couples seemed more inclined to seek the opinions of health care professionals (Rempel et al., Citation2004). Some nonpregnant partners mentioned that their lack of a physical connection with the unborn child made it easier for them to maintain an emotional distance (Côté-Arsenault & Denney-Koelsch, Citation2016).
Termination of Pregnancy
Eight studies suggested that nonpregnant partners were not always involved in decision-making processes associated with unintended pregnancies. In five of these studies, conducted in Cameroon, Canada, the Philippines, the United Kingdom, and Vietnam, women made decisions, either independently or collaboratively with their partners, regarding the termination or continuation of the pregnancy (Calvès, Citation2002; Costescu & Lamont, Citation2013; France et al., Citation2012; Hirz et al., Citation2017; Johansson et al., Citation1998). When the woman decided alone, partners were not always aware or informed about the decision to terminate the pregnancy (Calvès, Citation2002; Costescu & Lamont, Citation2013; Hirz et al., Citation2017; Johansson et al., Citation1998).
Some partners described feeling frustrated and powerless when their pregnant partners chose to terminate the pregnancy without consulting them. They were of the opinion that it should be a joint decision (Hirz et al., Citation2017). Sometimes, the partner’s involvement in pregnancy termination was mainly financial; in one study, half of the participating male partners reported paying for the abortion, and the majority of female partners reported making the abortion decision alone (Calvès, Citation2002).
Other studies, conducted in Vietnam, Kenya, Ghana, and Zimbabwe showed that the male partner often had a great influence on decisions about termination of pregnancy (Chibango & Maharaj, Citation2018; Johansson et al., Citation1998; Rehnström Loi et al., Citation2018; Schwandt et al., Citation2013). A Kenyan study showed that all women who informed their partners about an unwanted pregnancy opted for abortion. In many cases, the male partner pressed for pregnancy termination in an indirect manner; for instance, by declining financial or social responsibility for the unborn child. Additionally, some women mentioned being forced to undergo an (unsafe) abortion (Rehnström Loi et al., Citation2018). A study in Zimbabwe showed that, because of the male partner’s disapproval of abortion, women would rather report that they had a miscarriage than an abortion (Chibango & Maharaj, Citation2018).
Health Care During Pregnancy
Regarding health care during pregnancy, two qualitative studies described partners’ leading role in the decision to seek health care during pregnancy (Aarnio et al., Citation2018; Ganle et al., Citation2015). One study (Aarnio et al., Citation2018) conducted in Malawi, described how male partners, often the sole breadwinner, played an important role in decision-making about access to maternal healthcare; for instance, in case of pregnancy complications (Aarnio et al., Citation2018). In a study conducted in Ghana, the final decision regarding the use of maternal health care services was often made by male partners and mothers-in-law. Only a minority of the pregnant women were the final decision-makers; most of them needed permission from their male partner to go to a hospital. Women in polygynous relationships faced more difficulties accessing maternal healthcare, as their male partners did not allow them to give birth in the hospital if the other wives had given birth at home (Ganle et al., Citation2015).
Mode of Birth and Place of Delivery
Concerning the mode of birth and place of delivery, a Swedish study showed that women prioritize a safe and natural birth for their baby, whereas male partners are more concerned about women’s health.
Although most couples agreed on having a vaginal birth, some differed in their opinions on which mode of birth (natural birth or cesarean section) was desirable (Hildingsson, Citation2014). A study conducted in England among couples with a breech presentation showed that women often made decisions about the mode of birth together with their partners (Thompson et al., Citation2019).
In three European studies, the decision about the place of delivery (e.g., home or hospital birth) was generally left to the pregnant woman (Hollander et al., Citation2020; Lindgren & Erlandsson, Citation2011; Martínez-Mollá et al., Citation2015). Male partners indicated that women have the right to make decisions about their own bodies and decide for themselves what is best for them (Hollander et al., Citation2020; Martínez-Mollá et al., Citation2015). Moreover, male partners found it important to support their female partner in their decisions (Martínez-Mollá et al., Citation2015).
Culture
We observed salient differences in perceptions around decision-making authority depending on the country in which the study was conducted. Particularly, in non-Western countries, there appears to be more emphasis on male authority, especially related to pregnancy termination.
Theme 2: Communication Between Partners
This theme explores differences in the ways in which couples communicate about pregnancy-related decisions, encompassing the extent of and satisfaction with communication.
Extent of Dialogue
In one Swedish study on prenatal screening, couples indicated that they had engaged in superficial discussions regarding the decision and avoided deeper conversations. Some women mentioned that they had doubts about this avoidance strategy (Seidler et al., Citation2019). Another study, conducted in Iceland, found that male partners sometimes had missed the chance to talk about prenatal screening and get more information about the screening process (Gottfredsdóttir et al., Citation2009).
Another Scandinavian study showed that some couples did not feel the need to talk about participating in prenatal screening as they made their decision directly after the information visit with specially trained midwives (Wätterbjörk et al., Citation2012). Other couples indicated a need to discuss their own ideas before reaching a decision. Some of them had a lengthy conversation, especially about the moral issues related to prenatal screening (Wätterbjörk et al., Citation2012).
A Dutch study indicated that couples extensively discussed the place of delivery in high-risk pregnancies. Although couples often weighed the risks together, many partners were convinced by the women’s arguments about negative aspects of maternity care and the information they found online about alternative birth options. However, they accepted the responsibility for the outcome of their decision together (Hollander et al., Citation2020). A Spanish study also indicated that the choice for or against home birth was made after a lengthy discussion between the partners (Martínez-Mollá et al., Citation2015).
Satisfaction with Conversation
One study showed that some women would have appreciated a more thorough conversation with their male partner about the choice of whether to participate in prenatal screening. They felt frustrated for not being able to share their emotions concerning to this decision (Seidler et al., Citation2019). In another study, women and their male partners mentioned that, if disagreements occurred, they were resolved through discussion; for instance, about having a child with Down syndrome (Carroll et al., Citation2012).
Whereas some couples indicated they were satisfied with the amount of discussion that took place with regard to the decision to terminate an unintended pregnancy, others would have appreciated a more thorough conversation. Women were more often satisfied with the conversation than their partners. According to Costescu and Lamont (Citation2013), this could be attributed to the male partner having less influence in the decision-making process regarding abortion (Costescu & Lamont, Citation2013).
Theme 3: Informational Need/Knowledge
This theme is related to a couples’ and individuals’ need for information and their knowledge and understanding of pregnancy-related topics
A study by Aarnio et al. suggested that, in Malawi, men had limited knowledge about maternal health compared to women and often relied on their female partners for information. Although childbirth is culturally considered to be a woman’s domain, both male and female partners expressed the need for men to be better informed about maternal health (Aarnio et al., Citation2018).
Four studies conducted in Europe and the United States showed differences in the amount of information nonpregnant partners received and used during pregnancy-related decision-making. For instance, male partners were not always present at the consultation during which their pregnant partners received information about prenatal screening or diagnosis, and women did not always pass this information on to their partners (Williams et al., Citation2011). Several male partners indicated that they had wished to receive the same amount of information as their pregnant partner (Sjögren, Citation1992). Furthermore, male partners were often unaware of the potential risks associated with the birth plan proposed by their pregnant partners. They read little or nothing, and received most of the information from their pregnant partners. Compared to their male partners, pregnant women were more inclined to gather additional information on their preferred birth plan, mostly by using social media (Hollander et al., Citation2020).
Theme 4: Partner Involvement
The fourth theme relates to the involvement of the (male/nonpregnant) partner in decision-making and the different types of support provided by partners.
Preference for Involvement Versus Actual Involvement
Three studies showed that nonpregnant partners would have liked to be involved in pregnancy-related decisions. In a study conducted in the United States, partners of the pregnant women expressed a desire to actively participate in decision-making regarding prenatal screening and emphasized their role as part of a collaborative team. They perceived collaborative decision-making as a commitment to their pregnant partner, and a means of fostering connection with the pregnancy and future child. However, the extent to which partners were actually involved depended on the pregnant woman’s preferences; nonpregnant partners allowed their pregnant partners to decide about their involvement (Farrell et al., Citation2019). A study conducted in the United Kingdom suggested that nonpregnant partners felt less engaged in the decision-making process, and were often not encouraged by health care professionals to take a more active role. Sometimes, their questions and opinions were even ignored. Nonpregnant partners wished to be treated as a couple and considered it the responsibility of health care professionals to facilitate their support for their pregnant partner. They also suggested that their involvement could assist their pregnant partners in coping with challenging circumstances (e.g. decision-making, dealing with uncertainty) (Williams et al., Citation2011).
The studies by Williams et al. (Citation2011) and Locock and Alexander (Citation2006) discussed the role of the partner. In the study by Williams et al. (Citation2011), male partners indicated that, compared with their pregnant partners, they played a different role in the decision-making process regarding prenatal screening because they did not experience the pregnancy in the same physical way as their pregnant partner. Often they felt less emotionally connected to the unborn child (Williams et al., Citation2011). The study by Locock and Alexander indicated that, sometimes, male partners had the feeling that their parental role conflicted with other roles they were expected to fulfill. For instance, in cases where the fetal scan showed anomalies, it was their impression that they were expected to act as a supporter for their partner rather than as a grieving parent (Locock & Alexander, Citation2006). The authors link this role of the male partner as supporter to societal expectations of men “to conform to a model of masculinity in which emotion is not openly expressed” (Locock & Alexander, Citation2006, p. 1356). Moreover, this study showed that male partners were sometimes approached as “bystanders” by health care professionals. For instance, some of them were not offered a chair while the woman had a fetal scan. When the scan showed potential abnormalities, the feeling of being merely a bystander became even further intensified, as the focus of attention shifted entirely to the woman’s body and the unborn child.
Types of Partner Support in the Decision-Making Process
Several studies showed that nonpregnant partners provided various types of support in the decision-making process, especially practical, psychological, and emotional support. One study showed that women felt supported by their partners because they searched for information (Martínez-Mollá et al., Citation2015). Nonpregnant partners also found it important to help their pregnant partners navigate through the decision-making process by providing support during stressful moments of testing (e.g., circulating free DNA screening) or helping them acquire and process information in the counseling process (Farrell et al., Citation2019). Moreover, nonpregnant partners provided support in different ways when a soft marker was discovered at the routine ultrasound scan; for example, by explaining what the doctor had told them, providing comfort, or showing their understanding (Åhman et al., Citation2012). Male partners also indicated that they tried to support their pregnant partners (Carlsson & Mattsson, Citation2018) by trying to reduce the women’s fear during a genetic consultation by repeating what the counselor said (Browner & Preloran, Citation1999). Regarding decisions about pregnancy termination, one study indicated that nonpregnant partners tried to support their partners by maintaining their own feelings of sadness. They reported challenges in dealing with their partners’ distress and sought to downplay their own feelings of grief (Kecir et al., Citation2021). In a separate study addressing discussions surrounding abnormal prenatal test results, male partners indicated that it was their responsibility to provide emotional support to their partner and facilitate their decision-making abilities (Werner-Lin et al., Citation2016).
Relationship Characteristics
When relationships were perceived as less committed or short term, women did not feel consistently supported by their partners (Côté-Arsenault & Denney-Koelsch, Citation2016). Conversely, in unstable relationships, women sometimes did not inform their partners of their pregnancy or involve them in the decision to terminate the pregnancy. Some considered their partners unsupportive or even pressuring them toward abortion (Brauer et al., Citation2019).
Discussion and Conclusion
Discussion
With this scoping review, we aimed to gain more insight into the decision-making process of decisional partners regarding pregnancy-related topics. It became evident from the literature that the theme of joint decision-making has not yet been extensively addressed within this context. The included studies provided a range of views on the joint decision-making process. The degree of joint decision-making can vary depending on various aspects such as existing power dynamics, cultural norms, and the information available to each partner. Due to the diversity in the included studies, it is challenging to arrive at overarching conclusions because perceptions and experiences with decision-making differ. In general, the majority of women in the included studies indicate that they would appreciate their partner’s involvement in the decision-making process as a decisional partner who also shares responsibility for the decision made and potential outcomes of that decision. The desired extent of involvement and authority also depended on the type of decision. For example, with regard to termination of pregnancy, there was often less partner involvement. Furthermore, both male and female partners expressed a strong need for comprehensive communication and information exchange around pregnancy-related decisions. Our results are in line with the prevailing ethical consensus in most Western societies, that decisions during pregnancy should be made by the woman; she has the right to decide what happens to her body, especially with regard to major decisions such as pregnancy termination (Hollander et al., Citation2020; Longworth & Kingdon, Citation2011). Our findings are also supportive of the notion of couple autonomy. Couple autonomy refers to a situation in which both partners are individually autonomous and implies that decisions are reached through a process free of coercion, miscommunication, and manipulation, in which both partners have expressed their concerns and preferences (Matar et al., Citation2020; Osamor & Grady, Citation2018). Couple autonomy does not automatically imply that the final decision is made together or is supported by both partners; the question of who will be the final decision-maker depends on personal preferences of the couple and, for example, the cultural context. Our findings suggest that the role of the male partner also depends on the perceived quality of the relationship. Women in unstable relationships preferred their partner to be less involved in decisions. On the one hand, prospective fathers should be supported to be involved in pregnancy-related decisions and, in many situations, making decisions together may improve the decision process and outcomes (Aune & Möller, Citation2012; Geerinck-Vercammen & Kanhai, Citation2003, Elwyn et al., Citation2017). On the other hand, the ability of pregnant women to make autonomous decisions should always be protected (Malek, Citation2017).
Other factors that may hinder reaching couple autonomy are related to the lack of involvement of the male partner. We found that nonpregnant partners tended to be less involved in pregnancy-related decisions. They regretted missing opportunities for discussion and information gathering (Gottfredsdóttir et al., Citation2009). While expressing a desire for equal involvement, male partners often relied heavily on their pregnant partners for information (Browner & Preloran, Citation1999; Sjögren, Citation1992). Moreover, they felt frustrated for not being able to share their emotions (Seidler et al., Citation2019). When exploring factors that contribute to couple autonomy, the experience of feeling valued and appreciated by the partner seems pivotal, as this provides couples room for expressing and discussing their own thoughts before reaching a decision (Nazaré et al., Citation2011). In committed relationships, joint decision-making has been found to positively influence the quality of the decision-making process (Côté-Arsenault & Denney-Koelsch, Citation2016), potentially enhancing couple autonomy.
We found that in certain non-Western countries, male partners more strongly assert authority and influence pregnancy-related decisions, negatively influencing couple autonomy. This is supported by a study showing that, in Middle and Western Africa, less than 40 percent of the women can make their own decisions about reproductive health, whereas in Europe, 80 percent of women can make their own decisions (UNFPA, Citation2020). In more patriarchal societies, men control the economic resources and are therefore regarded as decision-makers in many or all aspects related to their female partners’ reproductive health (Yaya et al., Citation2019).
In addition, our review showed that male partners might exert (indirect) pressure, thereby limiting the autonomy of their pregnant partners; for example, by avoiding social or financial responsibility. This can place women in vulnerable positions and restrict their freedom of choice by compelling them to make decisions that may not align with their own values.
Health care professionals can support couples in achieving couple autonomy by encouraging male partners to take an active role in the decision-making process, instead of approaching them as bystanders, while taking context-related factors and the above-mentioned barriers to couple autonomy into account (Williams et al., Citation2011).
To ensure the quality of this scoping review, we followed the PRISMA guidelines and used the PRISMA flow diagram (Tricco et al., Citation2018). One limitation pertains to the fact that the articles were not assessed on quality, thereby allowing the inclusion of possibly lower quality studies. However, previous studies also debated the importance of including quality assessments in scoping reviews since this is not a priority of scoping reviews (Levac et al., Citation2010; Pham et al., Citation2014). Despite this limitation, this review provides more insight into the existing literature on decision-making of couples regarding pregnancy-related topics. This review has also benefited from the use of five databases to discover different articles and a specific data selection process with two reviewers, thereby ensuring that relevant studies were included in the review and that the precision of study selection for this scoping review was increased (Stoll et al., Citation2019).
Conclusion
Couples vary in their approaches to making decisions related to pregnancy, encompassing differences in decision-making authority, communication between partners, informational needs, and knowledge, as well as the level of involvement and support. Our findings highlight the importance of couple autonomy in pregnancy-related decision-making. Decision-making by partners, characterized by mutual respect and open communication, fosters a healthier decision-making atmosphere that is free from coercion (Becker et al., Citation2006; Story & Burgard, Citation2012). This shared responsibility allows for a wider exploration of options and, ultimately, contributes to the well-being of couples navigating pregnancy-related decisions (Osamor & Grady, Citation2018). Also, autonomy-supportive environments lead to better health outcomes (Powers et al., Citation2022). However, despite these principles, women’s autonomy in decision-making regarding their health is still weak in some parts of the world due to cultural norms (Sougou et al., Citation2020; Speizer et al., Citation2014; Sultana, Citation2011). Autonomy is a complex concept influenced by social relationships, and its acceptance in joint decision-making varies across different contexts. Even though we advocate for couple autonomy, it is essential to consider factors such as religious norms, background, and cultural traditions when evaluating autonomy in decision-making processes, and the impact of these factors should be further studied in the future (Lannoo et al., Citation2023).
Practice Implications
Multiple studies indicated that there is a need for decisional partners to be more involved in decision-making regarding pregnancy-related topics. However, due to the divergent findings, further research into the theory and practice of joint decision-making is necessary. It is important to explore the wishes and needs of both partners and to consider how joint decision-making can be integrated into counseling practices while guaranteeing couple autonomy before making more specific statements about joint decision-making. For instance, experiences such as pregnancy loss evoke emotional responses in both partners, underscoring the need to acknowledge and support the grieving process of male partners alongside female partners (Locock & Alexander, Citation2006). Grief knows no gender boundaries and both parents deserve care, support, and understanding from healthcare professionals.
Besides grief, prospective parents may encounter stressful decisions such as birth method selection and prenatal screening. During stressful moments, people tend to remember only a small portion of information provided by health care professionals (Kessels, Citation2003) and partners can help to acquire and process information in the counseling process (Farrell et al., Citation2019). This also highlights the importance of involving the partner in consultations regarding pregnancy-related decisions while taking contextual factors into account.
Ethical Approval
We did not obtain ethical approval because we only conducted a literature search for this scoping review.
Author Contributions
Yil Severijns: conceptualization, data curation, Writing-Original draft and Writing-Review & Editing. Liesbeth van Osch: conceptualization, Writing-Original draft and Writing-Review & Editing. Jesse Jansen: conceptualization, Writing-Original draft and Writing-Review & Editing. Esther Schutgens-Kok: conceptualization, data curation, Writing-Original draft and Writing-Review & Editing. Christine de Die-Smulders: conceptualization, Writing-Original draft and Writing-Review & Editing. Ciska Hoving: conceptualization, Writing-Original draft and Writing-Review & Editing. Marianne Nieuwenhuijze: conceptualization, Writing-Original draft and Writing-Review & Editing. Marieke Schor: Methodology, Writing-Original draft and Writing-Review & Editing. Hubertina Scheepers: conceptualization, Writing-Original draft and Writing-Review & Editing. Sanne van der Hout: conceptualization, data curation, Writing-Original draft and Writing-Review & Editing.
Patient Consent Statement
Not applicable.
Permission to Reproduce Material from Other Sources
Not applicable.
Disclosure Statement
The authors declared no potential conflicts of interest with respect to authorship and/or publication of this article.
Additional information
Funding
References
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