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Introduction
Poor collaboration has been identified as detrimental to the safety and experience
of maternity care. The Labouring Together study was conducted to explore women's and
clinicians' perceptions and experiences of collaboration in maternity care in Victoria,
Australia.
Methods
Underpinned by well-established conceptual theories of collaboration and shared decision-making
(SDM), a sequential, mixed-methods, multi-site case study approach was used to explore
women’s perceptions and experiences of maternity care in four diverse case studies
of public and private hospitals. Women's preferred and experienced role for SDM were
quantified using the Control Preferences Scale (CPS) and analysed using chi-square
analyses by case and socio-demographic characteristics. In depth interviews were conducted
to explore preferences and experiences reported by women.
Results
Most women indicated that they preferred an autonomous or collaborative role for SDM,
however 24.4% of women reported experiencing a passive decision-making role during
their maternity care. Statistically significant differences were identified between
the preferences and experiences of decision-making among women who chose private obstetric
care compared to public maternity care. The conceptual framework of Getting the Care that I Want and Need emerged from inductive analysis of qualitative data. Impacts upon women’s autonomy
over decision-making in maternity care included: access to midwifery models of care,
access to relational continuity of care; understanding of the rights of the woman;
and models information sharing for risks and benefits of all options and proposed
interventions. Bureaucratic style decision-making based upon a dominant discourse
of risk avoidance was identified as a major barrier, with power to ultimately veto
the woman’s choice
Conclusion
The Labouring Together study findings provide evidence to support women to use SDM
processes to enable decision-making in maternity care. However, fundamental barriers
were identified to hinder collaboration; and shared decision-making with women is
not routine practice in Victoria, Australia.
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© 2022 Published by Elsevier Inc.
