Women's Decision-Making And Factors Affecting Their Choice Of ...
Women's Decision-Making And Factors Affecting Their Choice Of ... Women's Decision-Making And Factors Affecting Their Choice Of ...
Chapter 7: Discussion The thesis explored women's perceptions of the childbirth process, and factors influencing their choice of place of delivery. It considered that one of the reasons women plan different venues for childbirth might be explained by their different perceptions of risk as related to childbirth. In chapter 1, the thesis tried to understand the present situation of place of birth in the United Kingdom, by looking at the events that led to it. For that reason, it traced the movement of the place of birth from the woman's own home to the hospital. History of place of birth identified government policy, which was influenced by the opinion of the medical establishment (Ministry of Health 1959; Department of Health and Social Security 1970; House of Commons Social Services Committee 1980), as having contributed to the move. The main argument for the government policy of encouraging hospital birth was that the hospital was safer compared to the home. However, the policy recommendations for hospital deliveries were made with no supporting statistical evidence for the allegations of safety, and, the policy was therefore questioned (Campbell and Macfarlane 1994; Russell 1982; Tew 1977; Tew 1978; Tew 1985; Tew 1990). However, it could be argued that government policy of hospital birth for all women might have left many women thinking that home was a risky place to give birth, while hospital was safe, and that is why they were being encouraged to go to the hospital. The debate about the safest place of birth intensified with time (Chamberlain 2000; Chamberlain et al 1997; Cole and Macfarlane 1995; Draper 1997; Drife 2000; Education and Debate 1996; Jowitt 1998; Macfarlane et al 2000; Settatree 1996; Springer and van Weel 1996; Young and Hey 2000; Alibahi-Brown 1999; Newburn 1999; Rakshit 1997; Rogers 1998; Young 1999). 183
Government policy about maternity care eventually moved away from a prescriptive service, to what should be a woman centred care, introduced by two government committees (Department of Health 1993b; House of Commons Health Committee 1992). The two committees advocate that women should be given information about services available to them to promote informed choice, which would lead to a client centred service. The patriarchal biomedical model that in the past has dominated health care in general, and maternity care in particular, is seen by the policy as out of date (Department of Health 1993b). The new health policy is putting forward a more participatory model in which decision-making is shared by providers and recipients of care. The thesis took on board the Department of Health's concern that women are not given adequate information to allow them to make informed decisions about their care, and set out to determine whether this was still the case. The second chapter tried to understand the theoretical view that might inform the way women perceive the process of childbirth, and how various factors might influence their preferences for home or hospital birth. The view of risk perception was considered, which posits that the perception of risk is influenced by individual characteristics and circumstances (Douglas and Wildavsky 1982; Johnson and Covello 1987). Examples were reviewed in the literature about how an event might be viewed as either being risky or not by individuals or groups depending on their circumstances and interests (Abraham et al 1992; Bagnall and Plant 1987; Dawson and Cynamon 1988; De Haes 1987; Douglas and Wildavslcy 1982; Johnson and Covello 1987; Regis 1988). The conclusion was that subjective factors influence decision-making, and, consequently, each person's view can be understood only in the context of their individual circumstances. 184
- Page 133 and 134: Table 9: Themes expressed by women
- Page 135 and 136: Table 11: Themes expressed about th
- Page 137 and 138: The results of the study therefore
- Page 139 and 140: Box 2: Pseudonyms of study particip
- Page 141 and 142: have registered so I can't remember
- Page 143 and 144: you have to be veru persuasive. her
- Page 145 and 146: waiAted to go to [name of hospital]
- Page 147 and 148: wavut to ask about it, and theo.. V
- Page 149 and 150: dedn't sort o-F tru AAA persuade me
- Page 151 and 152: anuthLng went wrong theyol have aLL
- Page 153 and 154: sometKng eLse when she saist, the h
- Page 155 and 156: arou.nd their necIR. all the time A
- Page 157 and 158: senuona: Mu fLrst one I had Ln hosp
- Page 159 and 160: agaLvt. when I had mu episiotomu th
- Page 161 and 162: khuma. iviu first daughter was a ca
- Page 163 and 164: nolope: olzau, I'LL give uou a fi.n
- Page 165 and 166: thought it would be, thlngs have oh
- Page 167 and 168: wtedwefe came around and spolze to
- Page 169 and 170: Some of the spontaneous responses f
- Page 171 and 172: or home. One woman thought that pro
- Page 173 and 174: N yttx1R,IA: we have got more contr
- Page 175 and 176: Sixty-nine percent of women plannin
- Page 177 and 178: expectations of what would best rep
- Page 179 and 180: Committee 1992) who observed that t
- Page 181 and 182: One of the fascinating findings of
- Page 183: Summary The qualitative study has r
- Page 187 and 188: choose (DiMatteo 1994), without any
- Page 189 and 190: Prospect theory (Kahneman and Tvers
- Page 191 and 192: IRYLOW, we tAIR,e eVeruthi.ne im, o
- Page 193 and 194: that may impact on the choices they
- Page 195 and 196: conducting home births, which might
- Page 197 and 198: looked after her during one of her
- Page 199 and 200: Appendices Appendix 1: (Information
- Page 201 and 202: Appendix 3a Consent form I the unde
- Page 203 and 204: 22. because I was in a hospital and
- Page 205 and 206: 76. the next one was being born her
- Page 207 and 208: 130. why are you wasting the hospit
- Page 209 and 210: 183. on the floor in agony go ahead
- Page 211 and 212: 237. went up and ran the bath for h
- Page 213 and 214: 292. not going near me, you know an
- Page 215 and 216: 346. and I said, well, you know, I
- Page 217 and 218: 401. it's not as ifsomething goes w
- Page 219 and 220: 455. you, I said , you're here to d
- Page 221 and 222: 510. nice. And the funny thing was
- Page 223 and 224: 566. through friends as well, they'
- Page 225 and 226: Appendix 5: Reflective notes Nnese
- Page 227 and 228: what do you think ofthe situation w
- Page 229 and 230: going horribLu wrong and suoldenlu
- Page 231 and 232: and he was quite sort of happy with
- Page 233 and 234: 60. you are dealing with somebody y
Government policy about maternity care eventually moved away from a<br />
prescriptive service, to what should be a woman centred care, introduced by two<br />
government committees (Department of Health 1993b; House of Commons<br />
Health Committee 1992). The two committees advocate that women should be<br />
given information about services available to them to promote informed choice,<br />
which would lead to a client centred service. The patriarchal biomedical model<br />
that in the past has dominated health care in general, and maternity care in<br />
particular, is seen by the policy as out of date (Department of Health 1993b). The<br />
new health policy is putting forward a more participatory model in which<br />
decision-making is shared by providers and recipients of care. The thesis took on<br />
board the Department of Health's concern that women are not given adequate<br />
information to allow them to make informed decisions about their care, and set<br />
out to determine whether this was still the case.<br />
The second chapter tried to understand the theoretical view that might<br />
inform the way women perceive the process of childbirth, and how various factors<br />
might influence their preferences for home or hospital birth. The view of risk<br />
perception was considered, which posits that the perception of risk is influenced<br />
by individual characteristics and circumstances (Douglas and Wildavsky 1982;<br />
Johnson and Covello 1987). Examples were reviewed in the literature about how<br />
an event might be viewed as either being risky or not by individuals or groups<br />
depending on their circumstances and interests (Abraham et al 1992; Bagnall and<br />
Plant 1987; Dawson and Cynamon 1988; De Haes 1987; Douglas and Wildavslcy<br />
1982; Johnson and Covello 1987; Regis 1988). The conclusion was that<br />
subjective factors influence decision-making, and, consequently, each person's<br />
view can be understood only in the context of their individual circumstances.<br />
184