Women's Decision-Making And Factors Affecting Their Choice Of ...

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about how to use that treatment in caring for individual patients. On the other hand, evidence without critical appraisal and application can lead to bad practice (Naylor 1995). A conscientious practitioner is one who tries to understand the complexities of medical or midwifery decision-making and appreciates the way in which knowledge skills, values, and research evidence are integrated in each patient-clinician encounter. The key is to use the available knowledge and research evidence to provide individualised care. Furthermore, systematic reviews, and therefore, the practice guidelines based on them may require modification as new evidence continually emerges. Multiple reviews may challenge guideline developers if they generate conflicting conclusions (Cook, Crreengold, Ellrodt et al 1997), which would call for careful critical appraisal of each review (Oxman, Cook, and Guyatt 1994), by considering the focus of the individual review compared to the specific purpose of the guideline to be developed. Particular emphasis should also be paid to issues of clinical and statistical heterogeneity of the reviews (Jadad, Cook, and Browman 1997). The present review was undertaken because although the topic of place of birth is often written about as discussed in the introductory chapter, women's views have not been made clear. It was therefore felt necessary to determine how much research has dealt with women's views, and to determine whether there were any gaps in knowledge about their views. Methods Before commencing the review, a check was made to determine whether a similar up-to-date review already existed, or had been commissioned or was in the process of being prepared. The verification was made in April 1999 in the 51
Cochrane Database of Systematic reviews (The Cochrane collaboration 1995), the Database of Abstracts or Reviews of Effectiveness (DARE) (NHS Centre for Reviews and Dissemination 1995) and the National Health Service National Research Register (NRR), (NHS Executive 1995). The databases were checked because they publish existing and commissioned research in the area. No such review was identified. The literature search was performed in the Bath Information and Data Services (BIDS) database, using the Institute of Scientific Information (1ST) Science, ISI Social Science, EMBASE (Excerpta Medica Online) and MEDLINE (Index Medicus Online) databases. The MIDlRS midwifery database, PsychLit, and a new database, the ISI Web of Science were also searched. The Web of Science consists of three large, multidisciplinary databases of Science Citation Index, Social Sciences Citation Index, and Arts and Humanities Citation Index that may be searched individually or in any combination. All three were searched in combination. The Cochrane database, which is popular for systematic reviews of health care research was also searched, but only had a meta-analysis of the safety of home versus hospital birth, which was not relevant to the present review. The idea was to amplify the search as much as possible to avoid missing studies. The search was done for articles from the last twenty years, from 1980 or date first available until July 2000. Reference lists of all the relevant papers were also examined to identify any studies not reached via the electronic search. An Internet search was done via homebirth homepages to identify any unpublished studies. 52
Page 1 and 2: Women's Decision-Making And Factors
Page 3 and 4: Figure 1: The paper elimination pro
Page 5 and 6: Home themes with supporting quotati
Page 7 and 8: Acknowledgements I would like to th
Page 9 and 10: Kingdom is a pluralistic society, w
Page 11 and 12: hospital delivery following a revie
Page 13 and 14: The committee issued a press notice
Page 15 and 16: The recommendations of the report u
Page 17 and 18: home. They also put forward the fac
Page 19 and 20: equirements for the maximum lowerin
Page 21 and 22: Previous committees had made their
Page 23 and 24: The majority of those interviewed f
Page 25 and 26: The Expert Maternity Group gathered
Page 27 and 28: • The woman and, if she wishes, h
Page 29 and 30: Chapter 2: Risk perception Chapter
Page 31 and 32: From the health practitioner's pers
Page 33 and 34: 1979), is a second approach to unde
Page 35 and 36: normative factor. The individual's
Page 37 and 38: and then choose the place they cons
Page 39 and 40: example, they worried that the valu
Page 41 and 42: they can easily imagine or recall a
Page 43 and 44: are not necessarily chosen because
Page 45 and 46: make decisions that are not necessa
Page 47 and 48: Chapter 3: Systematic review of fac
Page 49 and 50: considered. Primary research design
Page 51: If the question of the review is no
Page 55 and 56: Table 2: Search terms used Search t
Page 57 and 58: Table 3: Journals that were hand se
Page 59 and 60: solely on the basis of the study re
Page 61 and 62: they were recruited, at what stage
Page 63 and 64: ,,, ... .g eD .E 0 o 4,7; (.5 g .5
Page 65 and 66: -o -cs •b a) ..o ,:" .., -0 ti-,
Page 67 and 68: Quality of studies included in the
Page 69 and 70: ole to play in their preferences fo
Page 71 and 72: The next chapter discusses methodol
Page 73 and 74: observable behaviour are used (Holl
Page 75 and 76: known? What roles do values play in
Page 77 and 78: male nursing home is used (Applegat
Page 79 and 80: The procedure ensures a vigorous se
Page 81 and 82: investigation have for the particip
Page 83 and 84: In method triangulation, different
Page 85 and 86: the context being studied. They fur
Page 87 and 88: access to all settings, and the dat
Page 89 and 90: access participants' private accoun
Page 91 and 92: There is an argument for analysing
Page 93 and 94: analysis, asking additional questio
Page 95 and 96: that while such an approach can nev
Page 97 and 98: Chapter 5: Qualitative Study of Wom
Page 99 and 100: potential participants, as well as
Page 101 and 102: either. Three months passed, there
Page 103 and 104:
The interview was transcribed the s
Page 105 and 106:
elevant. The environment of the hom
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wanted to explore. Consequently, th
Page 109 and 110:
Most women offered coffee or tea, a
Page 111 and 112:
All women who participated in the s
Page 113 and 114:
The process of analysis was iterati
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h4,u husbovzi would sou thnt lie fe
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transcripts and compared them with
Page 119 and 120:
ecause they previously had short un
Page 121 and 122:
Figure 2: Analysis mind map Hospita
Page 123 and 124:
quotation in the transcript, denote
Page 125 and 126:
itiust put me off of birth, fuLL st
Page 127 and 128:
Gaolape brought up a number of fact
Page 129 and 130:
that presentation of much of the da
Page 131 and 132:
Table 7: Marital status Place of de
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
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Box 2: Pseudonyms of study particip
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have registered so I can't remember
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you have to be veru persuasive. her
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waiAted to go to [name of hospital]
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wavut to ask about it, and theo.. V
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dedn't sort o-F tru AAA persuade me
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anuthLng went wrong theyol have aLL
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sometKng eLse when she saist, the h
Page 155 and 156:
arou.nd their necIR. all the time A
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senuona: Mu fLrst one I had Ln hosp
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agaLvt. when I had mu episiotomu th
Page 161 and 162:
khuma. iviu first daughter was a ca
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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
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Sixty-nine percent of women plannin
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expectations of what would best rep
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Committee 1992) who observed that t
Page 181 and 182:
One of the fascinating findings of
Page 183 and 184:
Summary The qualitative study has r
Page 185 and 186:
Government policy about maternity c
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
Page 235 and 236:
112. Well I didn't Feel, you are to
Page 237 and 238:
1.o6. like Doctors ncl nurses and t
Page 239 and 240:
218. we are anti hospitals or anyth
Page 241 and 242:
Appendix 8: Thematic analysis Home
Page 243 and 244:
References Abraham, C., Sheeran, P.
Page 245 and 246:
Beck, C. T. (1993) Qualitative Rese
Page 247 and 248:
Chamberlain, J., Melia, J., Moss, S
Page 249 and 250:
Davenport-Slack, B. and Boylan, C.
Page 251 and 252:
Dingwall, R. (1992) Don't Mind Him
Page 253 and 254:
Fordham, S. (1997) Women's Views Of
Page 255 and 256:
Hammersley, M. and Atkinson, P. (19
Page 257 and 258:
Johnson, B. B. and Covello, V. T. (
Page 259 and 260:
Leap, N. (1996) 'Persuading' Women
Page 261 and 262:
Mather, S. (1980) Women's Interest
Page 263 and 264:
Morse, J. M. (1999c) Qualitative Ge
Page 265 and 266:
Patton, M. Q. (1990) Qualitative Ev
Page 267 and 268:
Commissioned by the Expert Maternit
Page 269 and 270:
Slovic, P., Fischhoff, B., and Lich
Page 271 and 272:
Tew, M. (1978) The Case Against Hos
Page 273:
White, V. M., Wearing, A. J., and H
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