Health Experiences Research Group, Department of Primary Health Care Sciences, University of Oxford, Oxford, OX2 6GG, UK.
Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
BMC Pregnancy Childbirth. 2018 Jan 8;18(1):12. doi: 10.1186/s12884-017-1601-4.
Current clinical guidelines and national policy in England support offering 'low risk' women a choice of birth setting. Options include: home, free-standing midwifery unit (FMU), alongside midwifery unit (AMU) or obstetric unit (OU). This study, which is part of a broader project designed to inform policy on 'choice' in relation to childbirth, aimed to provide evidence on UK women's experiences of choice and decision-making in the period since the publication of the Birthplace findings (2011) and new NICE guidelines (2014). This paper reports on findings relating to women's information needs when making decisions about where to give birth.
A qualitative focus group study including 69 women in the last trimester of pregnancy in England in 2015-16. Seven focus groups were conducted online via a bespoke web portal, and one was face-to-face. To explore different aspects of women's experience, each group included women with specific characteristics or options; planning a home birth, living in areas with lots of choice, living in areas with limited choice, first time mothers, living close to a FMU, living in opt-out AMU areas, living in socioeconomically disadvantaged areas and planning to give birth in an OU. Focus group transcripts were analysed thematically.
Women drew on multiple sources when making choices about where to give birth. Sources included; the Internet, friends' recommendations and experiences, antenatal classes and their own personal experiences. Their midwife was not the main source of information. Women wanted the option to discuss and consider their birth preferences throughout their pregnancy, not at a fixed point.
Birthplace choice is informed by many factors. Women may encounter fewer overt obstacles to exercising choice than in the past, but women do not consistently receive information about birthplace options from their midwife at a time and in a manner that they find helpful. Introducing options early in pregnancy, but deferring decision-making about birthplace until a woman has had time to consider and explore options and discuss these with her midwife, might facilitate choice.
当前，英格兰的临床指南和国家政策都支持为“低风险”女性提供分娩场所选择。选择包括：家庭、独立助产士单位（FMU）、助产士单位（AMU）或产科单位（OU）。本研究是更广泛项目的一部分，旨在为分娩相关的“选择”政策提供依据，旨在提供自发布《分娩地点研究》（2011 年）和新的 NICE 指南（2014 年）以来，英国女性在选择分娩地点时的决策经验证据。本文报告了与女性在决定分娩地点时的信息需求相关的发现。
2015-16 年，在英格兰，对最后三个月妊娠的 69 名女性进行了定性焦点小组研究。通过定制的网络门户在线进行了 7 个焦点小组，其中 1 个为面对面小组。为了探索女性体验的不同方面，每个小组都包括具有特定特征或选择的女性；计划在家分娩、居住在有多种选择的地区、居住在选择有限的地区、初产妇、居住在 FMU 附近、居住在选择退出 AMU 地区、居住在社会经济弱势群体地区和计划在 OU 分娩。对焦点小组的记录进行了主题分析。
女性在选择分娩地点时会参考多个来源。这些来源包括：互联网、朋友的推荐和经验、产前课程以及自己的个人经验。她们的助产士不是主要的信息来源。女性希望在整个怀孕期间都有机会讨论和考虑她们的分娩偏好，而不是在固定的时间点。
分娩地点的选择受到许多因素的影响。与过去相比，女性可能遇到的明显障碍更少，但女性并没有从助产士那里持续获得有关分娩地点选择的信息，并且不是在她们觉得有帮助的时间和方式。在妊娠早期引入选择方案，但推迟关于分娩地点的决策，直到女性有时间考虑和探索选择方案并与她的助产士讨论这些方案，可能会促进选择。
