What are the influences on women’s preferences and decision-making when planning mode of birth in high-income countries? A qualitative systematic review

Objective

In antenatal care in the UK NHS, the concept of choice of mode of birth (MOB) has been recommended for some years but is still poorly operationalised. Proactive, routine provision of balanced and relevant information to women in antenatal care can be supported by using decision aids but such an aid does not currently exist. The objective of this qualitative systematic review was to identify the factors shaping women’s MOB preference and the barriers and facilitators to supported MOB decision-making.

Data sources

Seven major electronic databases were searched for articles published in English between 2011 and November 2022. Study eligibility criteria Eligible studies were of any design and provided qualitative data from currently or previously pregnant women in high-income countries, about reasons for MOB preference, and/or barriers or facilitators to women making supported MOB choices. Data were extracted into a pre-designed data extraction form. Identified subthemes were grouped and mapped onto two preestablished global themes. Study quality was assessed using the CASP tool for qualitative research. Confidence in the findings was assessed using GRADECERQual.

Results

Women’s preferences for MOB were shaped by perceptions of advantages or disadvantages of each MOB and their own or other women’s previous birth experiences. Barriers to informed MOB decision-making were mainly relating to healthcare professionals’ (HCPs’) negative attitudes, which limited women’s perceived options, and women’s own strong personal beliefs and opinions. Facilitators included having time, support and information on which to make a robust decision.

Conclusions

Barriers to supported decision-making about MOB still exist. HCPs are well placed to guide women through the decision-making process. Informed implementation of decision aids has the potential to address barriers in supported decision-making about MOB in routine NHS antenatal care.