Risk perception and choice of place of birth in women with high risk pregnancies: A qualitative study
Introduction
The determination of risk in pregnancy is a complex process influenced by social and cultural factors (Chadwick and Foster, 2014). These include family histories, childhood experiences, nationality, and experiences of healthcare, and combine over time to establish an assessment of risk (Coxon et al., 2014). Women whose pregnancies are deemed medically as high-risk pregnancies will also make assessments regarding how at risk they feel. How women with high-risk pregnancies perceive the risks they face affects their decisions during pregnancy and labour, and the extent to which they follow advice from healthcare professionals (Bayrampour et al., 2012). Professionals caring for these women in contemporary Western society do so against a cultural background of increasing focus on the assessment and management of risk (Kringeland and Moller, 2006). Pregnant women's perception of risk is, therefore, of interest to the professionals involved in their care.
Evidence shows pregnant women and healthcare professionals do not define or assess risk in the same way. A recent systematic review (ref removed for blind review) found little association between the perception of risk by women and by healthcare professionals. It also found that women with high-risk pregnancies do not rate their risks highly; on average just below the midpoint of linear scales. This work is supported by a metasynthesis of qualitative studies (ref removed for blind review) which showed women with high-risk pregnancies are committed to the wellbeing of their babies and will take whatever steps they believe will achieve this. However this may not involve following all recommended medical advice.
Where to give birth is a key decision for pregnant women. While homebirth is considered medically safe for women with low-risk pregnancies (de Jonge et al., 2009), some women with more complicated pregnancies will also choose homebirths, often going against medical advice to do so. Reasons given by women for choosing homebirths against medical advice include the beliefs that hospital is not safer than home and that higher medical intervention rates in hospitals can increase childbirth risks (Jackson et al., 2012). Healthcare professionals are likely therefore to provide care for women whose decisions reflect perceptions of risk different from their own.
Obstetricians have reported difficulties when communicating with women with high-risk pregnancies (Pozzo et al., 2010). If women are reluctant to comply with medical advice, obstetricians may also be reluctant to discuss women's choices due to the fear of appearing to condone their decisions (Ecker and Minkoff, 2011). Healthcare consultations in Western society also usually occur against a cultural background which typically regards professional interpretations of knowledge as more reliable and objective than lay perspectives (Browner and Press, 1996). An increased understanding of how women with high-risk pregnancies perceive risk can, therefore, potentially improve communication with this group and facilitate understanding of their decision making.
The aim of this study was to investigate the perception of risk among a group of women with high-risk pregnancies. Half the women were planning to give birth in hospital and half were planning to give birth at home, despite medical advice to the contrary. The intention was to consider differences and similarities between the groups to examine how the perception of risk relates to the choice of place of birth.
Section snippets
Methods
This was a qualitative study using semi-structured interviews to examine risk perception and decision making processes in women with high-risk pregnancies booked to give birth at home or in hospital. This paper reports the analysis and results of women's perception of risk. Decision making regarding place of birth is reported elsewhere (Lee et al 2016). Ethics approval for the study was obtained from the North Tyneside II Research Ethics Committee. Recruitment took place between April 2012 and
Findings
Five similar themes came up in both groups of women concerning perception of risk: understanding of situation; judgement of risk; reassuring factors; impact of risk; and coping with risk. Similarities or differences between the groups are discussed within each theme. Direct quotes supporting the themes are provided, coded (Home1-13 and Hospital1-13) to maintain anonymity.
Discussion
The aim of this study was to examine risk perception in a group of women with high-risk pregnancies planning to give birth in hospital or at home. It identified five themes related to risk perception: understanding of situation, judgement of risk, reassuring factors, impact of risk, and coping with risk. This study extends the understanding of how women perceive risk and how this contributes to deciding where to give birth. It shows there are similarities and differences in attitude toward risk
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