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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.
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.
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
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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