Decision making styles and agency in childbirth: A mixed methods study comparing women's expectations to actual experiences during childbirth

Amy Witten, The University of Texas School of Public Health


Introduction: This study aimed to identify women’s preferences for agency and decision-making styles during labor and delivery using in-depth individual interviews taken during the third trimester of pregnancy and a follow-up interview after childbirth. The desire of women to have agency and decision-making capacity during labor and delivery as well as the factors that influence that process are in need of exploration. Describing women’s expected experiences versus their actual experience is helpful for informing childbirth preparation courses; informing caregivers concerning the timing and content of discussion of routine practice characteristics during labor and delivery; illuminating future research; and informing policy makers in institutions concerning the informed consent process during labor and delivery. Methods: Ten Caucasian (n=6), Hispanic (n=2), African American (n=1) or South Asian (n=1) women completed two in-depth interviews lasting between thirty minutes to one hour per interview between July 2013 and March 2016 for a total of twenty interviews. Interviews were conducted at a location agreed upon by the researcher and participant. The interviews were transcribed and analyzed using narrative analysis. Results: Women were in their childbearing years (M=31.7±3.5), and of varying socioeconomic status (40% completing high school only and / or receiving Medicaid for pregnancy, 60% completing college and having private insurance). Women discussed their preferences concerning decision-making during pregnancy and childbirth, mode and level of intervention during birth and their communication with their caregivers. Women who had previous births were asked about each birth experience in addition to the current pregnancy. All women interviewed expressed a desire to participate in decision-making during labor and delivery in the prenatal interview. Level of agency varied according SES group (Low: 66% paternalistic, 33% Shared Decision making, High: 30% paternalistic, 70% shared decision-making). Predominant factors affecting levels of agency and involvement in decision-making during labor and delivery included site of delivery (routine hospital procedure), relationship with hospital caregivers, and access to information both before and during delivery. Discussion: The findings from this study highlight the importance of hospital and caregiver procedures that provide women with the information and confidence needed in order for true informed consent to take place. There is a need for equal discussion of risks and benefits particularly for procedures occurring in non-emergency situations. The insights taken from this study may be used to help develop routine hospital policy informed consent procedures that improve women’s access to decision-making during labor and delivery as well as timing of labor and delivery discussions for caregivers.

Subject Area

Medicine|Ethics|Public health

Recommended Citation

Witten, Amy, "Decision making styles and agency in childbirth: A mixed methods study comparing women's expectations to actual experiences during childbirth" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10251606.