Choices for maternity care are they still ‘an illusion’? : A qualitative exploration of women’s experiences in early pregnancy

SummaryObjectiveThis paper presents a study exploring women’s experiences of making choices for maternity care in early pregnancy. The content will provide clinically useful information to midwives and health care professionals involved in caring for pregnant women.BackgroundChoice has been high on the maternity care agenda since 1993. Policies promoting choice were in part a response to critiques of the biomedical model, but also in recognition that an increased sense of control and quality of experience can have both physical and psychological benefits. Choice however may not be as straightforward as policy makers suggest and to date women’s own experiences of choice remain relatively silent in the debate.Methodology10 women took part in in-depth narrative interviews in early pregnancy, between 12 and 16 weeks gestation, in order to explore their choices for care, the rationale for those choices and their experiences and feelings at that point in their pregnancies.FindingsThree key themes emerged with regard to choice and revealed how women following a positive pregnancy test adopt a pregnant woman identity. This new identity invests them with both ownership of the pregnancy and a responsibility to the fetus to make the right decisions with regard to choices for care. Responsible choices are defined by both explicit and implicit influences and discourses, which fundamentally facilitate or inhibit choice.ConclusionOver a decade after choice was hailed as essential to ensuring a positive maternity experience for women, there remains a lack of evidence to suggest that choice is a reality for many women accessing maternity care.