to describe the extent to which women using maternity services perceive that they have exercised informed choice.
twelve maternity units in Wales.
postal survey of women using maternity services, covering women's views of the extent to which they exercised informed choice overall, and at eight decision points during their care.
1386 women at approximately 28 weeks gestation (antenatal sample) and 1741 women at approximately 8 weeks post delivery (postnatal sample).
54% of women perceived that they exercised informed choice overall in the antenatal sample (95% CI: 51-57%) and 54% overall in the postnatal sample (95% CI: 52-56%). Perceptions of informed choice differed by decision point, varying between 31% for fetal heart monitoring during labour and 73% for the screening test for Down's syndrome and spina bifida in the baby. There were differences by maternity unit, even when the characteristics of women attending these units were taken into account. Multiparous women, women from manual occupations and women with lower educational status were more likely to feel that they exercised informed choice during antenatal care. These sub-groups of women were also more likely to report a preference for not sharing decision-making with health professionals.
a large minority of women felt that they had not exercised informed choice overall in their maternity care. The perception of informed choice differed by decision point, maternity unit and characteristics of the woman.
attaining informed choice is more of a challenge for some decision points in maternity care than others, particularly fetal monitoring. The difference in levels of informed choice between maternity units highlights the importance of maternity unit policy in the promotion of informed choice.
"Only 9% of women wanted to be informed but not involved in decision-making, and 1% wanted staff to make decisions for them . A third study in Wales found that 90% of pregnant women and 83% of postnatal women preferred either to make final decisions themselves or to share decision-making with care providers . "
[Show abstract][Hide abstract] ABSTRACT: Health policy, guidelines, and standards advocate giving patients comprehensive information and facilitating their involvement in health-related decision-making. Routine assessment of patient reports of these processes is needed. Our objective was to examine decision-making processes, specifically information provision and consumer involvement in decision-making, for nine pregnancy, labour, and birth procedures, as reported by maternity care consumers in Queensland, Australia.
Participants were women who had a live birth in Queensland in a specified time period and were not found to have had a baby that died since birth, who completed the extended Having a Baby in Queensland Survey, 2010 about their maternity care experiences, and who reported at least one of the nine procedures of interest. For each procedure, women answered two questions that measured perceived (i) receipt of information about the benefits and risks of the procedure and (ii) role in decision-making about the procedure.
In all, 3,542 eligible women (34.2%) completed the survey. Between 4% (for pre-labour caesarean section) and 60% (for vaginal examination) of women reported not being informed of the benefits and risks of the procedure they experienced. Between 2% (epidural) and 34% (episiotomy) of women reported being unconsulted in decision-making. Over one quarter (26%) of the women who experienced episiotomy reported being neither informed nor consulted.
There is an urgent need for interventions that facilitate information provision and consumer involvement in decision-making about several perinatal procedures, especially those performed within the time-limited intrapartum care episode.
"Cuban women have a higher level of education and they are more capable to use information to have a better understanding of their condition but not necessarily to question doctors' point of view. In Thailand and Saudi Arabia information received by health personnel is not questioned, but is interpreted according to traditional cultural values . "
[Show abstract][Hide abstract] ABSTRACT: The results of a qualitative study carried out in four developing countries (Cuba, Thailand, Saudi Arabia and Argentina) are presented. The study was conducted in the context of a randomised controlled trial to test the benefits of a new antenatal care protocol that reduced the number of visits to the doctor, rationalised the application of technology, and improved the provision of information to women in relation to the traditional protocol applied in each country.
Through focus groups discussions we were able to assess the concepts and expectations underlying women's evaluation of concepts and experiences of the care received in antenatal care clinics. 164 women participated in 24 focus groups discussion in all countries.
Three areas are particularly addressed in this paper: a) concepts about pregnancy and health care, b) experience with health services and health providers, and c) opinions about the modified Antenatal Care (ANC) programme. In all three topics similarities were identified as well as particular opinions related to country specific social and cultural values. In general women have a positive view of the new ANC protocol, particularly regarding the information they receive. However, controversial issues emerged such as the reduction in the number of visits, particularly in Cuba where women are used to have 18 ANC visits in one pregnancy period.
Recommendations to improve ANC services performance are being proposed. Any country interested in the application of a new ANC protocol should regard the opinion and acceptability of women towards changes.
BMC Public Health 06/2003; 3(1):17. DOI:10.1186/1471-2458-3-17 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimsWe investigated the involvement of first-time mothers, who had a planned Caesarean section, in the decision to have a Caesarean
section, taking into account their different educational levels.
Subjects and methodsA self-assessment questionnaire was sent in July 2005 to women who had undergone a Caesarean section in 2004. Participants
were 2,685 members of a statutory health insurance fund who had given birth by Caesarean section (response rate: 48.0%). Included
were primiparae with planned Caesarean section (n = 352).
ResultsThe women in this cross-sectional study felt well informed about the procedure of a section but not its consequences. They
used several sources of information and were most satisfied with the information provided by doctors and midwives. Of the
women in this study 20% did not have a midwife. No major differences were observed between different educational levels.
ConclusionAlthough most women were satisfied with their decision, they felt that they did not receive enough information about the consequences
of a Caesarean section. This information need could be met by a further involvement of midwives in maternity care.
Journal of Public Health 08/2009; 17(4):273-280. DOI:10.1007/s10389-008-0246-1 · 2.06 Impact Factor
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