A mixed-methods study of women's birthplace preferences and decisions in England

Problem: Choice has been a key aspect of maternity care policy in England since 1993, however a gap remains between the birthplaces women want and where they actually give birth. Background: The latest maternity care policy in England acknowledges that women are not being given 'real choice' in their care and often being told what to do. This is problematic since unfulfilled preferences have been linked to negative childbirth experiences. Aim: To understand the factors affecting women's birthplace preferences and decisions, and why these might differ. Methods: A sequential mixed -methods study consisting of an online questionnaire (n =49) and follow-up interviews (n =14) with women who were either currently pregnant or had recently given birth in a metropolitan region in England. Findings: Most women in this study said that they would prefer to give birth in an alongside maternity unit because it offered a compromise between the risk of poor outcomes and risk of unnecessary medicalisation. However, the majority of women's preferences were medicalised at the point of decision -making as the minimisation of clinical risk was ultimately prioritised. Discussion: Women's preference for the alongside maternity unit demonstrates the growing popularity for this less medicalised, 'alternative' birthplace option. However pre-existing conditions, reproductive histories and experiential knowledge influence women's decision to give birth in the labour ward and suggests that minimising clinical risk is women's key priority. Conclusion: Women navigate complex and competing discourses when forming childbirth preferences and making decisions, selectively considering different risks and knowledges to make the decisions right for them.