Decision-making regarding place of birth in high-risk pregnancy: a qualitative study

Abstract

Introduction: Women consider factors including safety and the psychological impact of their chosen location when deciding whether to give birth in hospital or at home. The same is true for women with high-risk pregnancies who may plan homebirths against medical advice. This study investigated women’s decision-making during high-risk pregnancies. Half the participants were planning hospital births and half were planning homebirths.

Methods: A qualitative study using semi-structured interviews set in a hospital maternity department in the UK. Twenty-six participants with high-risk pregnancies, at least 32 weeks pregnant. Results were analysed using systematic thematic analysis.

Results: Three themes emerged: perceptions of birth at home and hospital; beliefs about how birth should be; and the decision process. Both groups were concerned about safety but they expressed different concerns. Women drew psychological comfort from their chosen birth location. Women planning homebirths displayed faith in the natural birth process and stressed the quality of the birth experience. Women planning hospital births believed the access to medical care outweighed their misgivings about the physical environment.

Discussion: Although women from both groups expressed similar concerns about safety they reached different decisions about how these should be addressed regarding birth location. These differences may be related to beliefs about the birth process. Commitment to their decisions may have helped reduce cognitive stress.

• Antepartum care
• decision-making
• high-risk pregnancy

Current knowledge on the subject

• Whether to give birth at home or in hospital is a key decision for pregnant women.

• Some women with high-risk pregnancies choose to give birth at home against medical advice.

• Safety is a key factor for women deciding on their birth location.

What this study adds

• Women planning to give birth at home perceive risk and safety differently to women planning hospital births.

• They also display a greater degree of confidence in their ability to give birth naturally.

• They place greater emphasis on the quality of the birth experience.