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Introduction: Although current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision‐making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth. Methods: We conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty‐five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi‐structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care. Results: Of 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision‐making (n = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt "backed into a corner" and "forced into homebirth," perceiving a lack of access to safe and respectful care in the hospital system. Conclusion: Some service users believe that home birth is their only option when they cannot access hospital‐based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recent laws, regulations, court cases and policies have included the requirement that people with disabilities be provided the opportunity to exercise informed choice in decision-making to promote inclusion and integration into society. These contemporary developments build on principles established in the early deinstitutionalization litigation, including rights to habilitation and to community settings as a remedy for unnecessary institutionalization. OBJECTIVE: This policy paper examines these regulatory, legal and policy changes to better understand the legal mandate for informed choice and its application to promote competitive integrated employment. METHODS: This policy paper analyzes the foundation of informed choice as presented in the Workforce Innovation and Opportunity Act (WIOA), the Home and Community Based Services (HCBS) Settings Final Rule, two landmark Department of Justice (DOJ) court cases (Oregon and Rhode Island) regarding shelteredworkshops, the Olmstead decision by the Supreme Court and recent interpretations of the Americans with Disabilities Act. The paper includes interpretations of informed choice from key civil rights lawyers in key court cases, reviews of case law, statutes, regulations, policy initiatives, executive orders, state Employment First initiatives and landmark settlement agreements. RESULTS: It is the authors' finding that, in combination, these laws, regulations and policies form a mandate for informed choice and create an affirmative obligation on the part of government entities to provide opportunities for people with disabilities to experience competitive integrated employment outside of sheltered workshops and other segregated settings as integral to making informed choices. CONCLUSIONS: The article posits that informed choice and the resulting affirmative obligation it embodies has not been sufficiently implemented by governmental and other private entities, and additional affirmative steps are needed to fully secure the legally mandated right to informed choice regarding employment services. [ABSTRACT FROM AUTHOR]

Objectives: To examine the 'nanny state' arguments used by tobacco companies, explore the cognitive biases that impede smokers' ability to make fully informed choices, and analyse the implications for those working to limit the harmful effects of other risk products. Study design: A critical analysis of the practices engaged in by the tobacco industry, the logic on which they relied, and the extent to which their work has informed approaches used by other industries. Results: The tobacco industry's deliberate strategy of challenging scientific evidence undermines smokers' ability to understand the harms smoking poses and questions arguments that smoking is an informed choice. Cognitive biases predispose smokers to discount risk information, particularly when this evidence is disputed and framed as uncertain. Only state intervention has held the tobacco industry to account and begun ameliorating the effects of their sustained duplicity. Evidence other industries are now adopting similar tactics, particularly use of 'nanny state' claims to oppose proportionate interventions, is concerning. Conclusions: Some marketing strategies have deliberately mis-informed consumers thus directly contributing to many public health problems. Far from removing free choice, government policies that restrain commercial communications and stimuli are pre-requisites necessary to promote free choice. [ABSTRACT FROM AUTHOR]

Leading maternity provider organizations in North America have been in conflict about birth at home and birth centers, debating issues related to safety, access, the value of obstetric intervention, and patient autonomy. In today's environment, childbirth educators and doulas are often required to explain to parents why physiological birth and evidence-based, low-technology methods of labor and birth care are not available in every setting, and why maternity providers disagree about birth place. There are very few regions in the United States where home birth providers are integrated into interprofessional provider networks that allow for seamless care across birth settings. In October 2011, multidisciplinary leaders met at a Home Birth Consensus Summit in Warrenton, Virginia, to discuss the status of home birth within the greater context of maternity care in the United States. This article describes the intent and outcomes of the summit. Four of the nine consensus statements developed at the summit are of particular interest and importance to mothers and families and, hence, to childbirth educators and advocates. Consumers, educators, and birth advocates are encouraged to widen the circle, identify communications experts, lead individual projects, or serve as advisors. [ABSTRACT FROM AUTHOR]

In the United States, federal acts and regulations, as well as professional guidelines, clearly dictate that every pregnant woman has the right to base her maternity care decisions on accurate, up-to-date, comprehensible information. Despite these efforts, evidence suggests that informed consent within current health-care practice is restricted and inconsistently implemented. Patient access to evidence-based research is imperative under the scope of informed consent and is particularly important during a time when perinatal mortality and morbidity rates, interventions, and disparities are on the rise in the United States. This article describes the Coalition for Improving Maternity Services' investigation of the breakdown of informed consent in maternity care. [ABSTRACT FROM AUTHOR]

Decision aids commonly include values clarification exercises to help people consider which aspects of a choice matter most to them, and to help them make decisions that are congruent with their personal values and preferences. Using a randomized online experiment, we examined the influence of values clarification on parental beliefs and intentions about having genomic sequencing for newborns. We recruited 1186 women and men ages 18–44 who were pregnant or whose partner was pregnant or planning to become pregnant in the next two years. Participants (N = 1000) completed one of two versions of an online decision aid developed as part of a larger project examining the technical, clinical, and social aspects of using exome sequencing to screen newborns for rare genetic conditions. The education-only version provided information about using genomic sequencing to screen newborns for medically treatable conditions. The education-plus-values-clarification version included the same information, along with a values clarification exercise in which participants classified as important or unimportant five reasons in support of having and five reasons against having their newborn undergo genomic sequencing. We conducted partial correlations, regression analysis, and MANCOVAs with sex, health literacy, and experience with genetic testing as covariates. Participants who completed the decision aid with the values clarification exercise agreed less strongly with four of the five statements against sequencing compared to participants who viewed the education-only decision aid. The groups did not differ on agreement with reasons in support of sequencing. Agreement with four of five reasons against genomic sequencing was negatively associated with intentions to have their newborn sequenced, whereas agreement with all five reasons in support of sequencing were positively associated with intentions. • Decision aids often use values clarification exercises to support decision making. • Beliefs impact parents' intentions toward genomic sequencing for their newborns. • Values clarification weakened beliefs that express reasons against sequencing. • By changing beliefs, values clarification indirectly influenced intentions. [ABSTRACT FROM AUTHOR]

In the United States, employment experiences of people with intellectual and developmental disabilities (IDD) have been dominated by discrepancies between recent policy shifts promoting integrated employment for people with IDD and the stagnation of the employment rate in integrated settings for this population. Although there is no direct source for labor force participation for individuals with IDD in the general population, data from the National Core Indicators Project suggest that, in 2015-2016, only 19% of working-age adults supported by state IDD agencies worked in one of the three forms of integrated employment-group-supported, individual-supported, or competitive (individualized and without supports). Twelve percent (12%) worked in competitive or individual-supported employment, and 7% worked in group-supported employment (Hiersteiner, Bershadsky, Bonardi, & Butterworth, 2016). In addition, individual employment supports have not been implemented with fidelity to a consistent model or set of expectations, and participation in nonwork services has grown rapidly (Domin & Butterworth, 2013; Migliore et al., 2012; Winsor et al., 2017)., (©AAIDD.)